“This is a gem for all consumers of health care and their providers. Finally a guide to make our patients active partners in their care. I really like the questions provided for the patients to ask. Dom is right on with the changes in health care and presents ways people can get what they need.” ~ Sheila David M.D., University of Toronto, Emergency Department Physician and Adjunct Professor of Medicine.
Don’t Go to the Doctor without Me!
Damiano de Sano Iocovozzi, MSN, FNP, CNS
Author of Sooner or Later: Restoring Sanity to Your End-of-Life Care
Published by Transformation Media Books at Smashwords
Copyright © 2011 Damiano de Sano Iocovozzi
Discover other titles by Transformation Media Books at http://www.smashwords.com/profile/view/TransformationMediaBooks
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
Dedication
To Francesca Ancona, Thanks for the memories!
To Rose de Sano Iocovozzi Seppi and Vincent Iocovozzi. Better parents one could never find.
To Mary, Cosmas, Gerri and Vincent, nicer siblings one could never find.
To Doctor Brian Kelber and the University of San Francisco, my ethics professor and my alma mater.
To Sue Sales, Donna Ross, Lorenzo Morales, Marguerite Bales, Mary Beth Dean, Dolly Smith, Lloyd, Peter and Hattie Spivak, Joe and Jimmy Thurston, Josephine Komos, Mary DiSano, Sharon Evered. Verna Favat Cristiano and Thomas Edwin Walls. All pillars of love and strength.
Table of Contents
Chapter One: Self-assessment and “Get Your Head On Straight!”
Chapter Two: Wellness Exam: Finding a Provider and Clinic
Chapter Three: The Episodic Visit, The Six Goals of Medicine, and the Forms of Disease
Chapter Four: Chronic Illness, Early On
Chapter Five: Chronic Illness, Later On
Chapter Six: Un-insured or Under-insured: It Pays to Shop
Chapter Seven: Conclusion and Going Forward
A special thank you to Drew Johnson who listened to me reading this volume over and over. Thank you to Ginny Weissman, my publisher, who encouraged me to keep writing. Thank you to Anjala Cariou who prepared the text of this work.
Thanks to my Twitter and Facebook friends who helped launch my first book with so many five star reviews.
As a child I liked living with happy surprises and have continued to do so as an adult. I never really expected to be a nurse as I was educated in languages at several universities, and at that time, I expected to be employed as a simultaneous translator or as an instructor of foreign languages.
After graduation, I was a Peace Corps Volunteer in Morocco where I taught English. After the Peace Corps in 1979, I moved to San Francisco as a tour operator and later got an International job as a tour director for a major travel corporation, using my language skills on world tours.
Suddenly in 1981, a mysterious illness emerged which caused tremendous fear and hardship. It was called AIDS and many of my acquaintances and a few friends were stricken. I found myself volunteering between tours and taking care of loved ones in their home or mine until they passed away.
One day, I was in a quandary about my ability to care for others and my lack of knowledge of medical care and nursing. I was sitting in a hotel room in Waikiki when I decided to go into medicine. After returning home, I was walking around the campus at the University of San Francisco and took a seat in front of the School of Nursing. A well-dressed lady sat next to me and we started to talk. I told her I was considering returning to school to study medicine since I saw the devastation since this epidemic began. She said I might want to consider a career in nursing. She pointed to a building that housed the School of Nursing where she was the Dean. That was in 1984. Since then I have 23 years of working at the bedside that to my surprise became my life’s work. Now I offer what I learned to you. I’ll be many things to you while reading this book: a trustworthy old friend, a doting godfather, a battle-scarred registered nurse. I will hold your hand. Now just call me Dom.
“Doctors are always working to preserve our health and cooks to destroy it, but the latter are more successful.” ~ Denis Diderot
This book is your personal road map through the health care maze as an adult, from wellness exams, episodic visits to chronic care management. The goal is to help you become your own health care advocate, getting the best, appropriate medical care possible. In our current economic times with fewer jobs and expensive health insurance, millions are uninsured or under insured. I will show you ways to get check ups and how to shop for needed services at the lowest price to keep you as healthy as possible even if you develop a chronic illness. This book is brief, to the point and provides you with ideas and questions for your health care providers.
Your relationship with your primary provider (physician, nurse practitioner or physician assistant) is an important one. This book portrays the realities of health care delivery and how you can find compatible clinics and providers, so you may stay healthy and thrive through your life. Centuries of tradition, the noble goals of medicine and a code of ethics have led up to your visit with your provider. This code, noble goals and tradition should guide your visits and govern how medicine is practiced, with you receiving the best care possible. However, these are most often just ideals, not a reality anymore.
In the new reality of health care, there are enormous conflicts of interest in this gargantuan medical business machine. This health care machine is changing how providers are educated, how medical research is conducted, how medical conferences are paid for, in addition to how tests, drugs and disposables are sold. The power and influence of the corporations and insurance carriers forming this medical industrial complex change the provider-patient relationship in indescribable ways. It is an environment you should be aware of as you seek medical attention as a consumer of health care.
Medicine is both an art and science. The art portion of a fine medical practice is good judgment and intuition and being able to sift through research results, to know if a medicine, treatment or protocol is appropriate for you. The best scientists or businessmen often make the worst providers without the art: intuition and good judgment.
Choose providers who combine the science with the art, know how to practice effectively and focus on you, the patient, respecting your autonomy and informed consent. This provider knows when enough is enough, does not over-treat or under-treat and will advocate for you and not abandon you when you are very ill. Part of your own advocacy is to do the same, knowing your own body, knowing when enough is enough or when you need to try something else.
Remember also that just because, a medicine, treatment or protocol exists, it may not be right for everybody. Give your provider all he requires to treat you effectively and cost efficiently based on scientific evidence along with the art of medicine: intuition and good judgment.
The medical process goes something like this: You visit your doctor who assesses you from a variety of sources: a physical exam, maybe some labs or a diagnostic exam like an x-ray, or maybe nothing at all. Using the art and science, the assessment data is evaluated. Some values or results may be inconclusive or red herrings. Others point to diagnoses that can be verified. Using intuition and good judgment, your provider may arrive at a diagnosis or may decide to take a wait and see approach. Your provider may intervene in the most informed way possible by prescribing a medicine, a treatment, or advice using a combination of rest and other measures. The last part of the medical process is evaluation. Was it effective or not? Knowing the landscape of modern medical practice leaves you better prepared, knowing you are your best advocate in an often perilous or indifferent setting. Use the tools in this book to find an appropriate medical home with a provider who demonstrates integrity, professionalism, compassion and who listens.
Navigating today’s health care environment is like rowing a small boat down stream in class two rapids: many boulders, shallows, impediments, sudden curves, spills and the occasional, enjoyable encounter of still waters. Don’t Go to the Doctor Without Me! is my gift to you after 23 years at the bedside in many roles. Consider this book your personal life jacket and me as your exclusive river guide through primary prevention, wellness maintenance, and for some, chronic illness care. Take this book with you when you see a primary provider and keep it nearby during your lifetime as the process of health care delivery doesn’t vary much. The goal of this book is to keep you in charge of your life and health care so you become your own advocate to get the best possible healthcare. This book does your homework, has the questions to ask your providers and prepares you to get the best care possible, with you at the helm.
Your guide will provide you with many behind-the-scenes details rarely shared, fish you out of murky waters and set you back on your way again.
It’s easy to use this book. For adult men and women, this book takes you through your yearly physical exam, your episodic (sudden, acute illness) visits for simple problems like urinary tract infections or bronchitis with easy cures. It continues with information for more serious, chronic conditions like diabetes, cancer, heart disease, high cholesterol or emphysema.
There are medical goals for chronic illnesses to keep you active and highly functioning for as long as possible. You will find out how the system works, what your providers expect and how you form a partnership with them based on mutual trust and respect. Courtesy goes a long way, too. You may also learn some basic terminology, what to ask for specifically, how your providers think and the goals of medicine in a framework of biomedical ethics.
Most importantly, this book will teach you how to think and act rationally if an unexpected illness arises for you or loved one. My hope is that you remain in control and in charge and always remember your provider is on your side.
This book gives you a way to look at yourself, your body, your choices to keep it functioning well, your personal relationships and how to live your best life, It will show you how to thrive in an uncertain world and a complex health care system.
You will learn what lab tests and diagnostics mean, how to find a provider you like and what to look for in a medical practice, what to expect and what not to tolerate. The wellness exams described in the reference section include the Pap test, the breast exam, the mammogram, the rectal and prostate exam, the labs and basic diagnostics.
In the chronic care visit goals change from a cure to a care orientation and how medicine works to maintain a high quality of life and a degree of independence. When a major illness comes along, this book becomes even more valuable, lessening your hardship, confusion and stress. My goal is to keep you as healthy as possible throughout your lifetime. As I pass the baton on to your primary provider, know you are better prepared to deal with anything that comes your way as you gain confidence in your partnership.
For those who might be confused about the meaning of a diagnosis, this book will help you frame the important questions you need to ask your health care providers to completely understand the estimated length and quality of your lifespan. Take this e-book with you along with a notebook to write the answers to the questions provided in later chapters.
Chapter I: The Self-Assessment and Getting Your Head on Straight
“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence liberates others.” ~ Marianne Williamson, Return to Love: Reflections on the Principles of a Course in Miracles
It is my belief that certain attitudes color our expectations and decisions. This also applies to our encounters with the health care system and providers. Our attitudes, beliefs and expectations may affect how we feel--stressful or joyful.
The health care system is like the layers of an onion with many people looking at you, the consumer of health care, in a medical-industrial machine. Getting the services or treatment you need could be steam-rolled by other agendas. As a consumer, you may face refusal of services, being uninsured or having little money to pay. This book is a valuable resource with the questions you need to advocate for yourself or loved one in the space of a ten minute visit.
Health care can be feast or famine, depending on your insurance coverage or money to pay for goods and services. With this in mind, it helps to see things as they really are with you placed in the middle between your provider and the medical business machine.
Here’s the real deal. You can be passive about seeing providers, hoping they will take pity on you and take care of you.. Or, you can be assertive, your own best advocate, courteously expressing what you need, prepared for your visit with your goals and questions in mind. This book will help turn you into an assertive person who is in charge, describes the problem, asks good questions, has faith in the outcome and is prepared to partner with the provider.
The reality in health care is that you are the responsible person taking an active role as a consumer. If you are a caregiver for an aged parent, you are the responsible partner taking an active role as your parent’s agent. This can be a difficult role: being an assertive consumer in a fast paced and often dysfunctional health care environment.
You are born with your genes but you can tweak your lifestyle choices to decrease your risk for certain diseases or accidents. Despite the commercial propaganda telling you can live forever and be forever young, there are no guarantees in life or insulation from bacteria, viruses or fatal illness. You can commit to healthy lifestyle choices and hope for the best: stop smoking, drink moderately, eat balanced meals, wear a helmet on your bike, practice safe sex, stop recreational drugs, take your prescribed medicine on time, get a yearly physical exam, visit the dentist and optometrist regularly, exercise and get a good night’s sleep.
Attitude is a major source of human misery or joy. Being optimistic and expecting things to work out well and for the best may set us up for more joy, better health and more fun.
From my 23 years at the bedside in many roles, I’ve learned a little about human beings and will gladly pass these snippets of wisdom on which may change everything for you. Think of yourself, your goals and your world view as I offer this advice to you, like an old friend.
Learn to be content with few possessions. There are no moving vans following a hearse.
Have patience when things don’t work out, have a plan B or C, just in case.
Live without fear, have courage and the knowledge that you are growing stronger with time and adversity.
Gather wisdom along the way from many sources.
Find a spiritual connection.
Let go of sorrow, grudges, disappointments and the fears of tomorrow.
Let go of false friends. Embrace those who stick with you through thick and thin.
Let life surprise you. Strangers are just friends you haven’t met yet.
Stop trying to be someone you are not. Tell the truth to yourself and everyone else.
Come as you are: straight, gay, lesbian, bisexual or transgender. You are born who you are.
You are an adult full of complexities, paradoxes and potential. You write the script for your life.
Think things through before speaking, acting and committing. Getting married, taking a certain job or degree or having a child are best thought through.
Life isn’t a dress rehearsal. This is it, right now. Today.
Aim higher than just showing up and going through the motions. You’ll miss or sleep through the best parts.
Your body is your personal space ship, so treat it as a temple.
Appreciate your beauty at any age, for every age is beautiful even those wrinkled faces that have smiled at others for decades.
My Personal Tipping Point
The tipping point for me occurred with my father when I was a little boy of six or seven around 1958. In those days, I followed my father everywhere. He was a sexton at a local cemetery and in the 1950s dug graves by hand. We often passed our family plot on the way to a grave site, both of us hauling picks and shovels. Families purchased large plots so members would remain together, even there. One day I asked my father to explain what the hyphen meant between the years of my deceased grandparents’ headstones.