Online Medical Advice: The New Prescription of Choice

The Internet seems to be turning everyone into pseudo-medical experts, as a matter of necessity as much as anything else. Physicians are busier than ever and the patients’ face-to-face time with them is progressively shrinking. It makes sense, therefore, to do some research online and then go to the physician’s office armed with a list of specific questions in order to make the best of that limited time.

Recently, I had an appointment with my physician. The nurse (or nursing assistant?) who was taking me through the pre-see-the-doctor process asked the usual questions: “Any changes since your last visit? Any new medications? Any complaints?”

I answered, “No” to all of those questions but then made an off-hand reference to having checked out something on the Internet. The nurse groaned, albeit with a smile on her face, and said, “Oh—the Internet!”

The short of it is that she feels her job is complicated by patients who pour over the Internet and then arrive for their appointments loaded with questions that require too much time to answer, or that she can’t answer. I should have asked the physician if he agreed, but didn’t think of it. No time—I had other questions.

I am sure that some aggravation can be a part of the interaction with the Internet-prepared patient but, in general, I think knowledge is power and, as health care consumers, we all can stand to possess a little power. I also see research on the part of the patient as improving efficiency and time management, in most cases.

Often patients who are dealing with dire diagnoses will scan the Internet trying to ferret out an obscure breakthrough medical study or a cure. While online searches may not reveal the miracle they were seeking, they can lead to physicians who can provide even more information.

Like it or not, we need to accept that patients will be turning increasingly to the Internet for medical information. In the wise words of Dr. Shalom Kalnicki, chairman of oncology radiation at Montefiore-Einstein Cancer Center, “It is important that instead of fighting against it, we join with them and become their coaches in the process.”

Have your patients’ Internet medical searches been a help or a hindrance in your experience?

Tell me about it.

Digital Mammography is Less Clinical, More Comfortable

Here in Colorado the aspen leaves have turned from quaking green to shimmering gold, signaling that the calendar page has changed over to October—and if it’s October, it is National Breast Cancer Awareness Month.

There are many facets to breast cancer awareness, but perhaps the most important are prevention and early detection. When considering early detection, breast self-exams and mammograms quickly come to mind.

Most women have likely read the meant-to-be humorous descriptions of how to prepare for a mammogram. The actual steps of the procedure are exaggerated in such a way that any woman who has had the procedure can relate in some fashion and chuckle at the over-the-top descriptions.

The descriptions sound something like this: Freeze two metal bookends overnight. Strip to the waist. Invite a stranger into the room. Place one bookend beneath one of your breasts, and place the other bookend on top. Smash the bookends together as hard as you can. Set an appointment with the stranger to meet next year and do it again.

I laugh at these things, perhaps because the procedure has never been torturous for me. I have wondered, though, if the poking-fun pieces might deter women who do find mammograms painful from having the procedure.

Well, I had my annual mammo last week—my first done with the use of digital technology. Let me tell you, in terms of comfort, digital mammography is light years ahead of film mammography. Women who found the procedure painful in the past should no longer dread their yearly exams.

With no statistics to back me up, I am supposing that hospitals of any size are using digital technology, or soon will be.

The entire experience at this year’s exam bore little resemblance to last year’s. There was the large dressing room, a keyed locker for my belongings, a thick, warmed terry cloth robe, no squishing the breast flat and no breath-holding while the x-ray was taken. After the procedure, the technician was waiting for me as I exited the dressing room, presented me with a fresh carnation, escorted me to the door and offered a cheerful farewell. What a difference a year makes!

The upgraded experience, however, pales in comparison to the increased power of cancer detection that digital mammography provides. Radiologists can now evaluate digital images with greater intensity and accuracy, due to the more refined resolution and finer detail of digital x-ray. This results in earlier and more timely detection of breast changes.

I am interested in the stories of those of you who have found film mammography to be unusually painful. Please share them.

Have you experienced the digital procedure and was it as comfortable for you as I found it to be?
Has the new procedure given you peace of mind, either from a detection standpoint or from that of not dreading future mammograms?

I Had Hoped I Was Immune, but I'm Not

Since my childhood, I have been told by adults, “Oh, you’ll see plenty if you live long enough.” And they didn’t necessarily mean good things. Illness is one of those not good things. “Every family is touched by cancer or other lingering illnesses,” they told me. “It’s a given.”

My mother is the next-to-youngest of eleven children. She’s 85 now and only she and her baby brother, two years younger, are still kicking—and kicking they are! Not kicking quite as high, certainly, but still getting around and enjoying life. My uncle, a raconteur extraordinaire, is still harvesting his avocados and hauling bushels of them to two farmers’ markets each week, where he finds that regaling customers with his endless repertoire of stories is much more fun than bringing home a stack of cash.

Of the eleven children, the youngest to die was 76, and it was totally unexpected—fine one day, gone the next, having passed peacefully in her sleep. The others mourned that she left them at such a young age (I admit that, at the time, 76 didn’t seem so young, but that was then). Several of the siblings lived into their 90s, and the rest into their 80s, and when they went it was pneumonia or other ravages of old age that took them, and it was quick. I’ve never endured the anguish of seeing a loved one slipping away slowly, inch by inch. In that regard, I’ve lived a bit of a charmed life—until now.

One month ago my sweet sister-in-law, my husband’s sister, was hit with a cancer diagnosis that stopped her (and the rest of us, albeit differently) in her tracks. The cancer is aggressive and her life expectancy is likely only a matter of months. Like every family in this situation, however, we have great hope that she will defy the prognosticators and grace us with her presence far longer.

The fact that she is the first of our generation to face such a tenuous future is a reminder to the rest of us of our certain mortality. It has caused us to examine our own futures, as well as the present. None of us is guaranteed limitless days and, although it is cliché, an event such as this really does push us to make the most of each one of them.

This lovely and gracious woman is an RN, a nurse anesthetist who, after several years, left the OR and returned to the bedside where she could interact more fully with her patients. She is a born caretaker, a little mother hen who showers her family and friends with attention and acts of thoughtfulness and kindness.

A reversal of roles is currently taking place. Now, the nurse is the patient, and instead of her looking out after the rest of us, we will become her caretakers and supporters and it will be a privilege to do so. Whatever we do, it will never be enough to match in kind the gentle gestures she has lavished upon us through the years, but, with heavy hearts, we will do our best.

Losing Weight for the Good of Others

I am a believer in Weight Watchers (WW). The food plan has evolved over the years and, while it has always been sensible, it is now flexible, easy to calculate and doable for a lifetime. For me, it all began with a big weight gain during a pregnancy. When I did not deliver the 60-pound baby I was counting on to make the pounds disappear, off I went to my first Weight Watchers meeting. Soon, I was back to my 125-pound pre-pregnancy weight, and decidedly more cheerful (just ask my husband).

My weight held steady for several years but, as many women know, the slower metabolism that comes with age, snatch-and-grab meals on the run and no regular exercise routine are a bad mix. The pesky pounds sneaked up on me again—probably while I was busy eating pecan pie muffins (they are so good, you wouldn't believe it). So, two years ago, I headed back to WW.

Again, I shed the pounds. Not only has my appearance improved, I have benefited from significant and positive changes in several aspects of my health—lab results, blood pressure and agility among them. This time I am not taking the chance (the very good chance) that I will allow pot roast and gravy to torpedo my hard work. Instead of the once-a-month weigh-in that WW recommends for those who reach their goal weight, I continue to go to weekly meetings, just as I did when I was in the losing-weight phase. The meetings, in fact, have become an important part of my social life and I look forward to them.

At the most recent meeting, an exciting new WW program—no, not a change in the food plan—was announced. The program is called Lose for Good, and the name doesn’t mean ‘get rid of weight once and for all.’ Rather, the meaning is ‘lose weight and do something good for someone else at the same time.’

Isn’t the world a perplexing place when two of its most serious health problems are polar opposites? I’m referring to obesity and hunger—too much to eat on the one hand, not enough on the other. During a six-week period in September and October, for every pound lost by WW members, WW will donate the monetary equivalent of one pound of food—up to one million dollars—to two hunger relief organizations, one domestic and one international. If members wish, for each pound of weight they lose, they can also donate one pound of non-perishable food and, at the end of the campaign, that food will be given to a food bank in their community.

I want to have the cushion of an additional small weight deficit to compensate for those times when the inevitable overindulgence occurs. Telling myself to just do it hasn’t been giving me the jump start I need, so this opportunity to do my small part to help the hungry is motivating me to lose a few more pounds. The thought of a child going hungry is a heartbreaker for me and this new campaign is a good reminder to be appreciative of the abundance I enjoy and to unselfishly share it with others who need it.

It makes me happy to Lose for Good. Are any of you planning to join in this effort? Tell me about it.

Professor of Nursing Writes a Guide for Student Success

My goodness, what took so long? Lots and lots of years after I graduated from nursing school, a professor at Rutgers College of Nursing in New Jersey has written a 256-page soft-cover book filled with sage advice on how to successfully take oneself from newbie student nurse to capable RN.

Robert Atkins, Ph.D., RN, canvassed nursing faculty, as well as seasoned practicing nurses who have professional contact with students, to gather insights into how a student can make the most of and get the most from his/her nursing education.

Getting the Most from Nursing School: A Guide to Becoming a Nurse covers myriad aspects of what a student encounters in school, from taking notes to writing papers to creating care plans.

Nursing school is emotionally demanding and plain hard work, whether it be studying and testing or on-your-feet clinical shifts. To become competent clinicians and caring nurses, students must learn the skills to anticipate challenges and, when they arise, to deal with them professionally. Atkins’s book shows the student the way.

Author Atkins says his aim is to help students with great potential become great nurses. The nursing profession and the nation’s health care system will be improved, according to Atkins (and who could argue with him?), by providing talented students with the tools needed to maximize their education. In turn, they are enabled to go on to be exceptional health care providers, policy makers, educators and researchers.

I am reminded of a statement (quoted here before) by the American Journal of Nursing’s editor-in-chief, Diana Mason, who said, "It does take a special something to be a nurse but it doesn’t have to be innate—it can be learned. With the proper desire, skills can be gained."

The Atkins book could give a student a leg up on becoming a superb nurse. In many ways, nursing students today are different from the students of my era. Few of us were married, those who had children were rare and we weren’t allowed to work at jobs outside our hospital. We weren’t pulled in so many directions. Today all of that has changed. Atkins’s book just might help today’s student stay focused and ease the stress of a plethora of responsibilities, both personal and education-related.