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Being Responsible For Your Own Health Care

This is part one in a series of posts on the topic of being responsible for your own health care.

Did you notice: something has changed in the way we do medicine. While technology has given some great advances in the 21st century, one of the biggest changes in medicine has been occurring for some time, starting in the mid-20th century. What is that change? Making the client the central person in the healthcare sphere. The way people become healthy – and stay healthy – relies heavily on the client’s motivation to take responsibility for their own medical care. Here’s how you can become the central figure in your health care, and help your medical team help you!

What’s Up, Doc?
Before starting any job for the typical healthcare setting, most employers ask potential employees to supply proof of essential vaccines to protect the patient as well as the employee. When I needed access to my own medical records for immunizations, I called the clinic who would have those records, only to be informed that the records were offsite, archived in a warehouse. When the record was pulled, they verified that records going past 10 years were no longeer accessible. Unless you still possess your yellow, hand-written record of immunizations (now completed with a stamp), you might be out of luck.

Instead of asking the all-knowing physician, “What’s up, Doc?”, you can anticipate answering a more important question that your doctor should ask you: “What ails?” The more you know about what is working for you and what isn’t in regards to your health challenges, needs, problems, and successes, the more you can help your doctor help you. Your knowledge of your health status helps every person who assists you — the customer care representative of your HMO, the MA who takes your vitals, the RN who attends to your shots, minor procedures, and triage, your PCP, and your surgeon or specialist.

Personal Health Record (PHR)

I tend not to remember numbers as well as other kinds of content. Remembering the date of the last time I had an allergic reaction to a medication is harder than remembering the allergen (i.e. an antibiotic, such as sulfa). But do you remember your blood sugar readings from two years ago? Do you know your lowest number? Your highest? The one that made you feel the best? Do you remember the month and year your father or mother was diagnosed with skin cancer? How about the kind of anti-depressant your father positively responded (and that you might have a fair chance at also responding favorably)?

Introducing the concept of the PHP, or personal health record. Instead of your medical record staying in your doctor’s office or an archive, your health record is released directly to you, either on a chip, or in a computer application you can download and access at anytime because YOU set it up. Two companies, Microsoft and Google, both launched applications to encourage savvy consumers like yourself to manage their own health records. Google recently cancelled its program, advising users that it will shut down Google Health by January 2012. Microsoft’s HealthVault is welcoming all users to create an account to store your sensitive medical records for your own access.

And there are other PHR’s from a variety of perspectives. was created by three people when a brother of the founders was diagnosed with ALS. People find communities of others with similar conditions, learn from one another,and even post info on clinical trials of medications. WebMD’s PHR is another very popular PHR, with an impressive transparency about their privacy terms.

How does curating a PHR make you responsible for your own medical care? Because you’re in the driver’s seat. You have access to your medical record, anywhere. You can add additional information as you go, even if your doctor does not send you an update for weeks. You won’t have to deal with HIPAA (Health Insurance Portability and Accountability Act), which functions for the realm of HMO’s but not for a software company (though they have their own privacy TOUA (terms of use agreement) to protect your sensitive information from being misused). When you have access to your own records, you have knowledge at your fingertips. Knowledge is power. With power, you are response-able.

Don’t Want To Be Responsible?

There is always someone who doesn’t like this kind of shift. Why not drive our bodies into the doctor’s office and let all the workers service them like cars? I’d caution you against this mindset. The best medicine is a collaboration between patient and physician, between client and provider. Input in, input out; garbage in, garbage out. Medicine is usually only as good as the motivation of the client to be well and administer the follow up care with attention and dedication towards wellness.

If this kind of medicine seems repugnant to you, my best recommendation is to take the whole — the responsibility of shouldering your own health care — and take small steps toward educating yourself about your health. Start with writing things down. File what you write about your health in one folder, or on one software application or memo. Ask for help in organizing your notes, or try a PHR program such as HealthVault. You won’t have to memorize which asthma inhaler you responded well to, or what diabetes medication worked the best, if you take a more active role in writing down your responses, dosing times, activity levels, and other pieces of information you are privvy to in a way no provider can ever be.

We are approaching 2012 with lightning speed. You decide if it’s time to become more responsible for your own health care and wellness. Once you make that decision, everything can change. Here’s to you, and a healthier 2012!

Change Client-centered Therapy Health care Online Therapy Therapy Washington

The Science of Observation Through The Senses

Do you feel like your therapist listens to you? Is there an appropriate time for a health care professional to touch you?

Listen to me, because I'm right here!

That’s an important question. In Washington State, touch between therapists and clients are limited to appropriate therapeutic touch, such as a handshake. However, I hold a license as a Registered Nurse, and there have numerous times when clients have shown me a wound that wasn’t healing, a mysterious rash on the arm, or presented with a cough that sounded more serious than the client was treating it [don’t worry: I always present my credentials, and ask a client if s/he would like my professional opinion on their medical question]. I might ask permission to touch near a wound to feel the temperature of the skin, or smell it to see if it is infected [or ask them to take a sniff if it’s within reach].  While I would never overstep the scope of my practice, I keep “Nurse Imei” ready for work when I’m in the therapy office, because it allows me to practice the best kind of medicine I know: the science of observation through the senses.

In an article posted on, Abraham Verghese MD, Professor of Medicine and Senior Associate Chair for the Theory and Practice of Medicine, Stanford University, wrote:

The truth is, I love and embrace technology, and have no desire to return to the pre-CAT scan and pre-MRI days of old. But I see no reason to let new technology make us lose the abilities we have had for over a hundred years to make sophisticated diagnosis at the bedside. Indeed, it should make us so much better.

I feel the same as Dr. Verghese. I too love technology and how it has enhanced medical practice. But it shouldn’t prevent or distract us from observing the client with out own eyes, ears, hands, and olfactory nerves. What does this mean for those of us who conduct therapy sessions over the phone, or handle triage in this manner?

If you are thinking of trying therapy over the phone or Internet, your therapist should be thoroughly trained to conduct sessions in this manner.  My telephonic nurse triage training gave me excellent experience in listening to patients because I could not see them. I can’t see a grimace of pain, but I can ask and help a patient evaluate their pain level using an appropriate pain scale. I can’t see if there is blood in their urine, but I can ask a client to describe a color or a smell. I can hear over the phone is someone’s breath is labored, or if their thinking is foggy.

If you are a client attending F2F psychotherapy sessions, it is important that your therapist look — or attend — to you. Attending is a developed skill, requiring hours of learning to observe a person’s normative behaviors, both physical and emotional, while they are describing issues that arise. Even if your therapist takes copious notes, a good therapist is watching body language, eye movement, changes in the tone or strength of your voice, the shifting of your body when you are uncomfortable with a subject, and even the presence of sweat and color changes to your skin. It’s not uncommon for a trained counselor to mention when s/he believes you’re not being honest about your problems.

As an RN, I feel exceptionally lucky to have additional tools of observation to bring to the table. Many of these help cast light on the overall picture of mental health. For example, knowing the complications of long-term sleep issues on the heart, as well as its connection to the incidence of depression, would lead me to prioritize a client’s complaint of poor sleep because his partner wakes him up when he snores. With more observation and interviewing, I could find out that the client has sleep apnea, a condition that contributes to depression, heart disease, and problems with a relationship.

I received a book as gift at Christmas, “The Naked Lady Who Stood On Her Head” by psychiatrist Gary Small and Gigi Vorgan. The stories highlight the many physical observations an MD notes, and they are often so many, I wonder how those without more medical experience (such as a physician or a nurse) function holistically in the mental health office. I must conclude that the best therapists I know rely heavily on observing through their senses, and documenting everything that seems unusual or unexplained. Anything falling the medical category gets noted and referred to a physician.

The corporate client who walks into an office with the smell of body odor and urine alert any therapist to inquire about the patient’s strong odor as a contrast to his normative grooming habits. But if you were trained to detect the smell of ketones on the breath of a diabetic experiencing the beginning of a sharp rise in high blood sugar, these are skills that can’t be as effectively used over the phone or Internet. And that is an important problem in the world of telemedicine.

When Telemedicine Isn’t Going To Work

A woman who has the smell of alcohol on her breath while going through treatment for alcoholism is not going to be detected if she contracts for telemedicine sessions. It is the practitioner’s responsibility to determine who should receive “old fashioned” health care in-office, and the convenience of telemedicine sessions should not be offered to everyone.

Technology has not caught up with our imagination. Some day we might have “smell-o-vision”, but as of today, we can’t smell through the phone. Someday, we’ll have more home devices that can measure heart rates and give us audio of a minute’s worth of auscultation (currently, there is an app that can do this for the heart, but it has not been approved for professional use). Until then, clients and providers should consider when therapy sessions are appropriate for phone and Internet, and when they should be seeing a helping professional face to face.

What do you think? What happens when clients leave the medical office saying, “My doctor didn’t listen to me, ” or “She barely even took a look at my symptoms”? How can we integrate crucial emerging telemedicine technologies with the need for old-fashioned observation?