Care Givers are the Face of Medicine...
A Valuable Resource

Care givers make the healthcare system work but ultimately we are in charge of our health. It's a responsibility that we delegate at our peril.

Let's start with a wonderful quote from Ernest Hemingway. He said, "I still need more healthy rest in order to work at my best. My health is the main capital I have and I want to administer it intelligently."

Hemingway had it right. The not so subtle message is that MY health is MY main resource and it is MY responsibility to take care of it.

In this section, care givers refer to medical doctors and nurses. Granted, there are numerous other indispensable disciplines in the healthcare system but the doctors and nurses are the ones we interact with face-to-face.

It may seem odd that a section on health care givers is included in a website titled "health-choices-for-life" with the theme "Healthy by Nature" and is devoted to getting well and staying well naturally.

Nevertheless, sooner or later, we will need the services of care givers; accidents happen, acute illnesses strike that need immediate attention or often, in spite of our best efforts to do all the right things, we still get sick.

The key is in knowing how to talk to your provider and this is what will be addressed here. For example, it pays to know a little bit about how your car works before turning it over to a mechanic to fix its problems. Otherwise, we are at their mercy.

Likewise, it helps to know as much as possible about how our body works before we blindly turn it over to the care givers for treatment. Just take a look at the statistics on how many people die each year from mistakes made by doctors.

The numbers are huge, tragic and preventable; learn what Iatrogenic Events mean and how they can impact our lives.

The takeaway messages are at the end of this page so feel free to skip to the end but first here's the main messages right up front; they are too important to skip over.

Here's the script, "Doc, I've been thinking of starting on this supplement, Are there any contraindications?"

If you ask your doctor what he thinks, you will get the standard response that supplements are a waste of money, there's no clinical trials, they don't get absorbed, you never know what's in them, etc, etc, etc.

"Contraindications" on the other hand, has a very specific meaning to a doctor and it will force him to do some research in order to answer the question...thus you have just contributed to his education.

Introduction to the Health Professions (Introduction to the Health Professions ( Stanfield))

While we're at it, a great book for anyone interested in the health professions is Introduction to the Health Professions shown above right. Click on the hot link to Amazon to get more details or to order.

Learning medical terminology is almost like learning a new language. Well, in the case of medicine you will learn quite a bit of Greek and Latin since many medical words and phrases are derived from those languages.

A good book for the layman on medical terminology is Slee's Health Care Terms, shown in the photo. To get your own personal copy, just click on the link to Amazon and buy the book. Simple.

Slee's Health Care Terms, Fifth Edition (Slee's Health Care Terms)

Now back to our Care Givers...Who are they?

Primary care providers (PCP) are the care givers we usually see first for checkups and health problems. If we have a health care plan, some thought should be given to determine what type of practitioner can serve as your PCP.

In most cases, it will be a medical doctor but these days, it may turn out to be a nurse practitioner which will be discussed below.

A "Generalist" is usually a medical doctor (MD) or doctor of osteopathic medicine (DO) who specializes in internal medicine, family practice, or pediatrics.

Obstetricians and gynecologists (OB/GYNs) are doctors who specialize in women's health care, wellness, and prenatal care. It is not unusual for women to use an OB/GYN as their primary care provider.

Nursing Disciplines

Registered nurses (RNs) have graduated from a nursing program, have passed a state board examination, and are licensed by the state.

Licensed practical nurses (LPNs) are state-licensed care givers who have been trained to care for the sick.

Nurse practitioners (NPs) are nurses with graduate training. They can serve as a primary care provider in family medicine (FNP), pediatrics (PNP), adult care (ANP), or geriatrics (GNP).

Others are trained to address women's health concerns and perform routine screenings and help with family planning. In some states NP care givers can prescribe medications.

Advanced Practice nurses have education and experience beyond the basic training and licensing required of all RNs. This includes nurse practitioners (NPs) and the following:

Licensed pharmacists have graduate training from a college of pharmacy.

A pharmacist prepares and processes drug prescriptions that were written by primary or specialty care givers. We would expect our pharmacist to give us information about our medications and to consult with our health care providers about dosages, interactions, and side effects of prescribed drugs.

SPECIALTY CARE

Primary care givers may refer patients to professionals in various specialties when necessary. The more common ones are:

Have you ever wondered what a person has to go through before they can become a full-fledged, practicing medical doctor?

In the United States, the first step is to complete four years of college with a high grade point average. Preferably, the undergraduate degree would be in biology or some health related natural science.

Next is to pass the Medical College Admission Test (MCAT) with competitive scores.

The next step is gaining admission to a medical college where the next four years will be spent in full-time study.

The first two years of med school entail classroom and lab work followed by two years in working with patients while under the supervision of a doctor.

Then comes the residency program which can last from 3 to 8 years. Residencies offer the prospective care givers paid training and work experience while deciding on a specialty.

All states require a licensing exam prior to being licensed and certified to practice medicine.

Now you are a doctor! Oh, by the way, it's time to start making payments on your $100,000+ student loan debt.

The whole study of medicine is changing so rapidly that much of that learning is obsolete by the time the new care givers are ready for practice. The volume of knowledge mandates specialization.

Even within a chosen specialty, the sheer volume of papers, clinical trials and results, new treatments are so daunting, that it is impossible to keep entirely up to date.

Could this be the driver behind all those "Ask Your Doctor" drug commercials on prime time television? Does big pharma think our M.D. care givers don't know what to prescribe for us?

Must be, since they are training us in prime time commercials to "ask your doctor" if Lipitor or Boniva or Cialis or Caduet or whatever is right for us.

Time for reading and keeping up with new developments is a luxury for most care givers in our current US Healthcare environment.

Continuing Medical Education (CME) is required for all medical disciplines but all too often time is still a critical factor and there is pressure to get the course done, get the credit and satisfy the requirement. Depth is often lacking.

The growth in the number of nurse practitioners has coincided with a decline in primary-care physicians, a troubling trend that experts say is leaving many patients without rapid access to qualified care givers.

Today, medical students are more apt to choose a higher-paying specialty field like ophthalmology or dermatology over the main primary-care fields of pediatrics, internal medicine and family practice.

A study published in September in the Journal of the American Medical Association found that only 2 percent of students planned to go into primary care. In 1990, it was 9 percent.

The result is that more patients say they can't find nearby doctors or have to wait weeks or months for an appointment with their primary care giver.

In 2007, only 30 percent of Americans said they were able to get same-day appointments with their doctors when they were sick, a survey by the New-York based Commonwealth Fund indicated.

Arizona ranks 43rd in the nation in number of physicians per capita, with 208 for every 100,000 residents, according to 2006 statistics from the U.S. Census Bureau.

According to a report from the Association of American Medical Colleges in Washington, D.C, an immense shortage of physicians is impending. Population growth, aging and other factors, will cause demand to outpace supply through at least 2025. Complex changes such as improving efficiency, reconfiguring the way some services are delivered, and making better use of our physicians will also be needed.

The projected shortfall was attributed to a slowly expanding physician workforce in the face of an expected 50% growth in the U.S, population and a doubling in patients older than 65.

Projecting current utilization trends, the report predicted that the demand for physician care givers would grow 26.3% from 2006 through 2025. It would require 859,300 physicians to meet that demand, but there will only be 734,900-resulting in a shortage of 124,400.

It was the AAMC's first workforce report since 2006, when it said that a 30% increase in the total number of physicians would be necessary to ward off a major physician shortage.

In the new report, the largest shortage is projected in primary care and surgical specialties, said the AAMC.

"There is broad recognition of the central role of primary care givers in the nation's healthcare delivery system," said the report. "Until recently, though, health workforce projections have largely neglected primary care.

Our baseline projections produce a greater shortage in primary care than in any other specialty area. In fact, the projected shortage in primary care accounts for more than a third of the total projected shortage in 2025 (37% of the overall physician shortage, or about 46,000 full-time equivalent primary-care doctors)."

At the same time, inpatient care will be the setting of greatest need.

"If current patterns continue, the hospital inpatient setting is projected to experience the single greatest rise in demand (36.6%). All the other settings are projected to face increases that, while still substantial, are notably less than the growth in demand for physicians in inpatient settings.

Surgery is the only other setting with projected cumulative growth in demand that exceeds 25% by 2025. Nonetheless, the projected increase exceeds 20% for every setting."

That projected shortage was based on current medical trends, but the number could be much higher in the face of shifting trends, such as younger physicians working fewer hours than their older counterparts.

The report suggested that moving rapidly to provide coverage for all Americans before creating significant improvements in how medical care is delivered could fuel the workforce problem.

If universal healthcare coverage becomes a reality, overall demand for physicians would go up by 4%, which would increase the shortfall by 25%, or an extra 31,000 physicians.

While an increase in medical school capacity has been suggested as a way to fill the physician pipeline, the report said that a "robust expansion" of such capacity would only reduce the projected shortage by 43%, which would still equal a deficit of 70,000 physicians.

The report added, "Shortages are likely to be manifested in a number of ways, including longer waiting times for appointments, increased travel distances to get care, shorter visit times with care givers, expanded use of non-physicians for care, and higher prices. If shortages are extensive, in some cases it will lead to a loss of access to care givers altogether."

In addition to increasing medical school capacity, the report suggested a number of shortage-mitigating factors including:

The last point is important because studies show minority care givers are more likely to work in underserved areas, which are predicted to be hit hardest by the shortage.

If the looming doctor shortage is bad, the national nursing shortage is horrible. Within the next fifteen years, we could be facing a shortage of over half a million nurses.

The forces responsible for the shortage of nursing care givers are exploding numbers of aging baby boomers, nurse retention problems in busy hospitals and the inability of nursing schools to produce enough graduates to meet the demand.

Medical school grads get on-the-job training during formal residencies ranging from three to seven years. Many newly licensed nurses do not have a similar protected period as they build their skills and get used to a demanding environment.

For too many care givers in the nursing profession it is a sink or swim, on-the-job-training evironment; not fair to the nurses and dangerous for the patient.

So more hospitals are investing in longer, more thorough residencies. These can cost roughly $5,000 per resident. But personnel experts estimate the cost of recruiting and training a replacement for a nurse who washed out is about $50,000.

One national program is the Versant RN Residency, which was developed at Children’s Hospital Los Angeles and since 2004 has spread to 70 other hospitals nationwide.

One of those, Baptist Health of South Florida in the Miami area, reports cutting its turnover rate from 22 percent to 10 percent in the 18 months since it started its program.

The Versant plan pairs new nurses with more experienced nurses and they share patients. At first, the veteran care givers do the bulk of the work as the rookies watch; by the end of the 18-week training program, those roles are reversed.

The new nurses must complete a 60-item checklist. They must learn how to put in an IV line and urinary catheter; interpret different heart rhythms and know how to treat them.

They must also monitor patients on suicide watch and do hourly checkups on very critically ill patients; know how to do a head-to-toe physical assessment on a patient, as well as how to inform families about the condition of their loved one.

The Rise of Nurse Practitioner Care Givers

During the past five years, the number of nurse practitioners in the United States has increased by nearly 40 percent, to 125,000, according to estimates by the American Academy of Nurse Practitioners.

The trend is being driven in large part by a shortage of primary-care doctors or general-practice physicians, medical experts say.

Although most NPs work in settings supervised by physicians, more are striking out on their own, opening and staffing their own clinics apart from doctors.

That has generated some controversy in the medical community, as physicians worry about the risk of misdiagnosis if NPs don't work collaboratively with licensed physicians.

"The nurse practitioner replacing the family doctor is not good for America," said Dr. Ted Epperly, president of the American Academy of Family Physicians. "To say a nurse practitioner can fill the shoes of a family physician, in terms of the total comprehensiveness of care, is just not true."

Nurse practitioners say such concerns are overblown. They maintain that most NPs are careful to stick to treatments that they are licensed to provide and that they send patients to doctors for any serious problems.

They say they are filling a void for many Americans who have trouble getting timely and unhurried doctor appointments.

"There is a need," said Sharon Campbell, a Tucson nurse practitioner who opened her own practice in 2004. "We fill that need." These care givers may prove to be the new face of health care as the doctor shortage get worse.

Role of Nurse Practitioner Care Givers

Arizona is among about a dozen states that allow nurse practitioners to treat and diagnose patients, order tests and prescribe medications without collaborating with a physician.

That means they can work independently in almost any field, including family practice, pediatrics and women's health. Some own practices that specialize in psychiatry, dermatology and managing or preventing heart disease.

State law doesn't limit what services nurse practitioners can provide, but it does say they should consult with outside care givers when dealing with a condition that exceeds their expertise.

Most NPs have at least a master's degree and have completed 500 to 1,000 hours of supervised hands-on training, under guidelines set by the American Association of Colleges of Nursing.

Increasing numbers of NPs are getting doctorate degrees because accredited programs are requiring them, including those at Arizona State University and the University of Arizona.

By 2015, all NP programs will require a doctorate, said Mary Jo Goolsby, director of research and education for the American Academy of Nurse Practitioners.

Going to the doctor's office is never fun and besides it's getting more expensive by the day. So it makes sense that when we absolutely, positively, have to see a doctor, we would want to make the most out of the visit.

Remember how this page was introduced? Our health care is our responsibility. The doctor is someone we hire when we need advice or treatment for a health issue. That means we are the boss, we pay the bills.

It also helps to understand how healthcare gets delivered in the U.S. healthcare system. The book below is written for the person who really wants to learn about the system but it's not for the casual reader. It is a university level text book so if that is your interest, click on the title link to get more information.

Health Care USA: Understanding Its Organization and Delivery

Now just because we pay the bills, it doesn't mean that we should second guess our care givers; but we should not leave until we understand everything about our health issue and the resulting diagnosis.

Rule number one...Always level with the doctor. Tell the truth, don't try to hide embarrassing information or try to be the tough stoic. If you have been smoking two packs a day, drinking a fifth of bourbon a day and living on Big Macs, tell it like it is.

Care givers can't provide the best service possible unless they have complete information. When we present ourselves to the doctor, if he is worth his salt, he will be observing our signs but we have to relate our symptoms.

When we try to downplay our symptoms or bad lifestyle choices, we are only cheating ourselves.

Rule number two...Get what you pay for. We expect a complete diagnosis and a course of treatment so be sure to get it.

Don't just accept the latest, greatest prescription without knowing exactly what is wrong, how it happened, why this particular medication is prescribed, what it does and the expected outcome from the treatment.

Rule number three...Ask questions, lots of questions. For example, with a new prescription, be sure to ask about all known side effects and interactions.

Interactions would include other drugs, food, herbals and dietary supplements.

When I started taking the supplements that I have been using for about seven years now, I took all the material about them to my doctor and told her I would like her to look at it so she would know what I was taking.

Some was written, some was on descriptive DVD's. A few days later, I got all the material back in the mail with a note saying she was afraid to put the DVDs in her computer and didn't really have time to look at the material.

I never went back. In effect, I fired her and she was the only doctor in my network. Her message to me was that her time was more important than my health.

Back to rule one, it is our responsibility to make sure care gives know what other drugs we are taking as well as what herbal remedies and supplements we are using; otherwise how can he be expected to answer the interaction question adequately.

This is especially important if we are seeing more that one doctor and getting prescriptions from multiple sources.

And while thinking of prescriptions, care givers are quick to prescribe a drug but not so quick to tell us when to stop taking it or to start weaning ourselves off it.

If taking several prescriptions, always ask if there is any that could be safely stopped. Remember, all drugs are poison and all have side effects and interactions. Taking prescription drugs is an unnatural act and should not be viewed as a life sentence.

Drugs are one thing, surgery is something else. A lot of people die every year from unnecessary surgeries or, worse, pick up a fatal bacterial infection from some Superbug while in the hospital getting that unnecessary surgery.

If our primary care givers are surgeons; they are going to want to cut on us...that's what surgeons do.

So always explore thoroughly why a surgery is needed, are there alternatives, what are the dangers and what complications could arise. We cannot let our care givers minimize their feedback to us.

Some years ago I needed a hernia operation; no doubt that it was needed. I was referred to a surgeon by my primary care provider and in my first meeting with the surgeon, I asked how long he had been doing these operations.

He laughed and said I would be his first and tried to move on with the preparatory paperwork. I made him answer the question plus several more about his practice, experience and outcomes. The last thing we need with our care givers are stand up comics.

Rule number four...Get the doctor to focus on root causes. The usual problem is that once the diagnosis is made, thinking stops by both care givers and patients, and out comes the prescription pad.

Speaking of thinking, here is a very illuminating book dealing with doctor's thought processes in arriving at a diagnosis and treatment. It should be required reading for patients as well as doctors. Click on the link below to order.

How Doctors Think

Here's a template of what to ask..."Oh, you say I have high blood pressure and high cholesterol and you want me to take Lipitor (or Crestor or Zocor)?

Why is my blood pressure and cholesterol high? How did it get that way? What can I change in my lifestyle to get it back to normal? What changes can I make in my diet to get it back to normal? Do I need stress management training or more exercise?"

Or, "Oh, you say I am diabetic and need to start taking Metformin (or Januvia or Diamicron)? How did I get diabetic, what went wrong? How can I change my eating habits to control my blood sugar? What about exercising? What if I lost 30 pounds? Sure, I can give up donuts."

Or, "Oh, you say I am developing osteoporosis and you want me to take Fosamax (or Boniva, or Actonel, or Forteo)? What if I just quit drinking, started strength training and took calcium citrate, magnesium, vitamin D and K and zinc and boron instead?

Would that help? What if I supplemented with soy, flaxseed, arugula and sea vegetables? Would that reverse the trend toward osteoporosis?"

Or, "Oh, you say I have irritable bowel syndrome and you want me to take methotrexate and prednisone?

Don't those have some pretty severe side effects? What else can I do? How about something to control inflammation like a regimen of omega-3 and fatty acids?

How about a natural supplement to modulate the immune response? What about dietary adjustments and probiotics? Are milk or dairy products upsetting my system?"

No matter what the diagnosis, there will likely be a drug for it. The standard questions for our care givers are always geared to finding natural solutions that don't carry side effects and interactions plus lifestyle changes that will keep us out of the prescription drug spiral.

Focus on the existing lifestyle and how it can be changed for the better; to include dietary changes, physical activity, stress management, sleep quality, supplementation, or attitudinal adjustments involving laughter and joy.

Rule number five...Educate yourself on diagnostic tests and ask the doctor about performing tests pertinent to your health issue.

For example, according to Drs. Hyman and Liponis (ULTRAPrevention), 70% of Americans are deficient in zinc. This can lead to numerous allergies, fatigue, frequent colds and a depressed immune system. A simple taste test can reveal a zinc deficiency. So we might want to ask our care givers about possible deficiencies.

There are about 60 or so autoimmune diseases characterized by inflammation. A simple test for C-Reactive Protein will reveal inflammation in the body thus giving an important clue to what is going on.

There are numerous tests available; some that can be performed in the doctor's office or lab; others must be done by big commercial labs such as Quest Diagnostics, Dynacare and several others that you have to visit in person.

The various diagnostic tests can be classified according to the origin of the disease. They are nutrition, metabolism, inflammation, detoxification and oxidative stress. The more common diagnostic tests and their purpose are itemized below.

Nutrition

Carrots, garlic, onions and cucumbers, as shown in the photo are all great sources of essential vitamins and minerals.

Nuts, especially walnuts, flax, cold water fish and eggs are common sources of the essential fatty acids.

Red meat, chicken, soy products and lentils are good amino acid suppliers.

For an in-depth discussion on all the essential nutrients with links to each essential category, navigate to "What do I need for optimal health?"

The more common tests for proper nutrition are listed below.

Metabolism

Key tests for metabolic efficiency include:

Want to play with a metabolism calculator? Go to "How Many Calories Do I Burn in a Day?"

C-reactive protein is a protein found in the blood, produced by the liver and fat cells, specifically related to inflammation.

Tests for inflammation include:

While cold water fish is highly touted for its essential fatty acid content, large fish are especially contaminated with heavy metals; mercury in particular.

Now it is safer to consume smaller fish or get the omegas from supplementation; just be sure the omega supplement is produced by molecular distillation and is pharmaceutical grade.

Oxidative stress

Free radicals produce oxidation in the body, the equivalent of rusting in metal. The ionization of oxygen which produces the free electron is caused by toxins, diet, stress, sunlight, and numerous other agents.

They are with us and we can't avoid them but we can detect them and deal with the problem by the use of natural antioxidants. Most of the colorful berries are super antioxidants. Antioxidant testing includes:

The tests listed above are from the book ULTRAPrevention by Doctors Mark Hyman and Mark Liponis.

You can check out their website at www.ultraprevention.com to learn more about these tests, how to interpret them and what to do about abnormal results.

Their site also offers an incredible amount of information on health tips and tools and guidance on natural health that you won't find anywhere else.

You can also jump to Amazon to buy the book; just click on the link. It is a must have for any natural health library.

Ultraprevention: The 6-Week Plan That Will Make You Healthy for Life

And if you want to go all the way with Ultra, consider the Ultra Collection, an audio-book combining Ultra-Metabolism and Ultra-Prevention in one CD package. Click on the "Ultra" link below.

The Ultra-Collection

Their site is also full of priceless information on Prevention, Health and a Tips and Tools for personal health.

It would almost be worth it to get sick if we could be certain of finding care givers like these two. They are my standard in what a doctor should be.

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