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STEPS TO A HEALTHY HEART: GETTING GOOD MEDICAL CARE
When the cardiac event occurred, you came under the care of a cardiologist and possibly a cardiac surgeon. In an ideal situation, those specialists will keep in close contact with your family physician, general practitioner, internist or whoever you rely upon for usual care if, indeed, you have a regular doctor. If you’re from a small town, and you received cardiac care away from home, reports will be sent back so that your doctor will know what’s happened, what to expect, and how treatment should be continued.
During the first weeks, you’ll rely a lot on your cardiologist. He’ll be the one, most likely, to do your exercise treadmill tests and to set the course for your rehabilitation program. He’ll also be the one to prescribe special medications that you may take for a short period of time or possibly for the rest of your life. For details on cardiac medications see chapter 16.
But there’ll come a time when your care will and should be transferred back over to your regular doctor if you have one. Indeed, you’re better off with a family practitioner or an internist rather than relying on a cardiologist for too long a time.
First, the cardiologist is highly specialised and may not be up to date on other physical and medical conditions that you’re dealing with. Second, the general practitioner or internist has a great deal of knowledge about cardiology and can make a smooth transition.
In fact, it’s the general practitioner or internist who is more likely to provide expert advice for your specific, individual situation. Cardiologists don’t normally give dietary counselling, stress management input, hypertension management and so forth on a daily basis. It’s the family practitioner who does those things routinely and is best suited to do so.
Of course you probably will go back to your cardiologist periodically for re-evaluation, including an annual treadmill test and perhaps other testing as called for. But when it comes to normal aches and pains and ongoing cardiac recovery, your family practitioner, GP or internist will have principal responsibility for your health.
Some patients become overly dependent upon their cardiologist, feeling that he and only he has the expertise needed. Think of this another way. If your doctor referred you to a urologist for a specific problem, would you continue to rely on the urologist for all your medical attention?
Because your family doctor will be such a vital member of your health team from now on, it’s really important for you to have confidence in him or her and to feel comfortable with his or her care. (Yes, there are many female physicians, but for the sake of brevity for the balance of this discussion, I’ll refer to the doctor as he. No sexism intended.)
This is the time to ask yourself quite candidly, do you really like your doctor? Do you think he has the medical horsepower you need to feel confident? Is he the kind of person you can sit and talk with, expecting to get the answers you need for the questions that are so important to you? If so, count yourself as quite lucky. Not everyone has such positive feelings about his doctor. If you’re not completely happy with your current doctor-patient relationship, this is the time to do some shopping.
Unless you live in a very remote area where you’re lucky to have any medical care at all, you have your choice of quite a few doctors. In fact, in many if not most major population centres doctors are in abundance and actually are anxious to get new patients. You’re in a buyer’s market.
We all have warm, fuzzy feelings about having a doctor like Marcus Welby, MD. He always had time to talk with his patients, to take a walk with them through the palms, and to get to know their entire family intimately. Although that situation was obviously exaggerated for the purposes of television drama, there are many caring physicians who feel deeply about their patients. I’ve personally known dozens of them.
As a side note, I’ve been asked a number of times whether I feel doctors are jaded and uncaring, and whether working on my books has given me a negative impression of the medical community. I’m very happy to say that the result of my work has been exactly the opposite. Sure, there’s a doctor here and there who cares more about his real estate holdings and stock portfolio than his patients, but those are in the minority. Both the doctors who are in practice and those doing research in medical centres and universities are highly dedicated, compassionate people. I’ve been proud to be associated with them, both directly and indirectly.
So how do you find a good doctor? First consider the characteristics that are important to you. Would you feel comfortable with a very young person, or do you need more maturity? Bear in mind that age does not always equate with knowledge, however, and many “youngsters” have state-of-the-art information and training that their seniors lack. Should the doctor have privileges in a certain medical centre or hospital that you’ve come to like? Do you need a doctor with a marvellous bedside manner, or would you prefer a practitioner who has tremendous medical credentials?
Many studies have shown that some women feel much more comfortable with a female rather than a male physician. This is particularly true for older women. There are certain subjects that are just too personal to be discussed with a man, even though he’s a doctor. If that’s the case for you, by all means make an effort to find a good female physician. There are plenty of them.
I personally think that a very important characteristic for any physician is his or her own optimism. I’ve mentioned this trait as a predictor of success in recovery for the patient. It’s no less vital for the physician, who can convey that sense of optimism, that you’re going to be fine. Optimism is highly contagious. You want to catch it from your doctor!
For years, many have recognised the physical as well as psychological benefits of the so-called “laying on of hands”. Just a doctor’s warm and caring touch seems to be a conduit for reassurance, just as a Mummy’s kiss seemed to make that scraped knee “all better”. It turns out that there’s actually a scientific basis for this phenomenon. The University of South Carolina has been gathering data under a National Institutes of Health grant to learn just why tender loving care works. Apparently there is an electromagnetic field that transfers energy from the hands of an accomplished and caring healer to the patient. Is it all in the mind? Researchers at McGill University in Montreal have shown that the principles even apply to animals, as shown in terms of wound-healing in mice.
But a word of warning. Beware of quacks and charlatans who are expert in bedside manner and providing reassurance, but have no scientific basis for their treatments. Those who practise chelation therapy fall into that category. Chelation is an unproven treatment which purports to remove arterial blockage through a series of injections. Sure, they can tell you about “thousands” of patients who “feel 100% better” after their treatments. But they have no proof to show that it was their ministrations that made the difference. If a patient is willing to shell out thousands of dollars in chelation therapy, it’s likely that he’ll also make dietary changes and get additional exercise. Here’s the bottom line: if chelation therapy really worked, virtually every doctor in the country would be happy to add it to his medical repertory, not only to aid his patients but also to be able to collect additional fees.
You need help. You don’t need hindrance. Not only will quacks and charlatans take your money, they could wind up taking your life by standing in the way of sound medical care that could help you beat heart disease.
So how do you find this doctor who’s just right for you? Talk with your friends. Are they happy with their physicians? Ask your cardiologist for a referral, telling him what you’re looking for in a family physician.
Call the local medical society for a listing of doctors with the qualifications you seek in your area.
Then go talk with them. There’s absolutely nothing wrong with doing a bit of “shopping” for a person who will be providing services that are, quite literally, a matter of life and death. If a doctor refuses to spend a few minutes with you just to get to know you, you know right off the bat that he or she won’t have time for you later on when you really need it. But remember, of course, that time is precious to all doctors. Keep the meeting short and to the point, having your list of questions in hand. Some questions might include:
How long have you practised?
How many patients do you see per day?
What hospital(s) have given you privileges?
Are you board certified in your area of practice?
What is your availability on weekends and holidays?
How often do you attend continuing education programs?
How many medical journals do you read weekly?
Can you provide a list of references?
Before your meeting, while waiting in the reception area, chat a bit with the nurse or receptionist. You’ll quickly pick up on how they feel about the doctor. Good doctors have staff members who practically worship them.
If your doctor suggests a certain treatment, and you’re not certain about whether it’s right for you, by all means seek a second opinion, even a third opinion. No good doctor would be insulted by that, and he should be willing to provide whatever X-rays and lab results necessary.
And if your doctor or cardiologist has suggested that you need angioplasty or bypass surgery, you’ll certainly want to interview the potential practitioner. Cardiologists normally do angioplasties, although some radiologists do them as well. And bypass surgery is strictly the domain of the cardiovascular surgeon. Again, have your list of questions in hand:
Where did you receive your training?
How long have you done this type of surgery?
How many surgeries do you perform weekly?
How many surgeries are done at your hospital weekly?
? What is your morbidity (medical complications) and mortality (death) rate?
If you’re not completely comfortable in interpreting the answers to those questions yourself, consider discussing the matter with an objective third party such as your family practitioner.
We’ve come to take bypass surgery for granted in this day and age in our society, and we sometimes believe that it’s as easy as having a decayed tooth filled. (Even at that, don’t you want a good dentist to fill your tooth?) The fact remains that the mortality rate differs enormously from one doctor to another and from one hospital to another. It’s your heart and your life. You deserve the best. Don’t settle for less.
Happily, excellent cardiac surgeons are available in virtually every area of the country. If you have to travel a few kilometres, or even more than a few kilometres, to get to the best one, it’s worth the trip.
*60/85/2*

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