Dr. Kevin Most: Cervical cancer and being a good patient
The impact of celebrity health issues
The power of the media with celebrity health often makes an impact that is far reaching. Angelina Jolie publicly coming out and sharing her fight with breast cancer and Ben Stiller sharing his story with prostate cancer heightened awareness around screening for those diseases. This past week we heard about sportscaster Erin Andrews and her treatment of cervical cancer. In each of them the celebrity status brought the story to the forefront but the treatment was not exactly what the medical experts would want to promote. For example, Ben Stiller had his PSA test done well before the recommended time frame for men, and Erin Andrews returning to work well before the time we would want individuals to return to work follow procedures.
The impact of each is that we are reminded how screening for diseases can be helpful in treatment.
We have touched briefly on women’s health in the past. The thought is that women take great care of their children’s health, nag their husbands until they seek care but sometimes they also need to reminded of health care.
This past week we saw and heard about Sports Journalist, Erin Andrews and her recent fight with cervical cancer. If you missed it, Ms Andrews was diagnosed with cervical cancer in September. She had surgery in early October and five days later she was standing on the sidelines working a NFL game. She admits that the doctor did not recommend that she do that but she did it. She has had follow up test in November and it appears that she is cancer free and not in need of any chemo or radiation.
The point I wanted to bring out is not that she was back at work 5 days later but more that she received the necessary screening to allow her to receive treatment that actually is curative. We have had a lot of discussion in the past about the need for screening and this just highlights the need for cervical screening. Cervical screening is very important and some recent news about the survival of women with cervical cancer is a bit alarming. The reason for the alarm is that the death rate is actually much higher than has been reported. This change is not due to any medical treatment changes but just some math. Before this adjustment the death rate due to cervical cancer continued to include women who had a hysterectomy. As the cervix is removed with a hysterectomy, the true statistics should remove these individuals from the chance of dying from the illness. As they recompute the rates the death rate goes up dramatically. The total number of deaths from cervical cancer has come down over the past 4 decades, as the screening Pap smear has gotten better with increased accuracy. Now the women who do die from cervical cancer are often those who did not have routine screening and are diagnosed to late in the disease process.
Cervical cancer is a cancer that is easily treated when noted early, and now with the advent of HPV vaccine the cancer could be prevented and actually eliminated. We know that the HPV virus causes cervical cancer so eliminating the chance of a HPV infection eliminates the chance of cancer. When the vaccine came out there was some controversy as the goal is to vaccinate individuals before they are sexually active as HPV is transmitted with sexual activity. Parents need to get over that concern and think of the lifelong protection from cervical cancer that this vaccine provides.
As we study more and more cancers, we may find more links with Cancer and viruses. Estimates are that up to 15% of all cancers have a foundation with a virus. Examples include Hepatitis B virus is linked to liver cancer, EBV the virus responsible for mono is also linked with specific lymphomas and again, HPV is directly linked to cervical cancer. Identifying the link and preparing a vaccine will make a bigger impact than celebrity media exposure.
How to be a great patient, or what to do before coming to the doctor.
How many of you have walked out of a doctors visit, get in the car and go “Damn” I forgot to ask ………, well you are not alone. Studies have been done that show that although patients feel they have a great physician, they often feel they did not communicate well with their physician. This is a combination of being afraid to ask a question or forgetting the question you have. Often we think that the only prep we have to do for a doctors office visit is plan on getting there on time. This could not be further from the truth. Lets go over a few simple things.
First there is no such thing as a stupid question- patients are always afraid to ask a question that they think the doctor may find crazy, but they are not afraid to ask a coworker or friend the same question. “Do you think this mole is concerning ?” is not the question you want answered by Joe in accounting. Believe me, after practicing for a while, we have heard every question in the book, so do not be afraid to ask.
The question you may feel is dumb may actually be a very serious question, a simple symptom you may think is nothing may be a huge red flag for us. Also part of our job is to educate you about conditions, symptoms and side effects that you may have. Often you think we are too busy but let me assure you we would rather respond to concerns in that setting than on the phone later or in the middle of the night. There is a reason we went to school for at least 23 years. Remember you are paying the bill, please ask us the questions, we will answer them with respect.
So what happens? First remember you have an appointment and prep for it. This prep may take place over months or days, but stop and think what has been concerning you about your health or any general question you may have. Write them down, keep them in your notes in your phone and add to them between appointments. Once you are in the office it is too late to organize your thoughts or concerns, we need your insurance card, fill out this information sheet, check your information, update any changes, sign these forms, you are stressed, and now you are in the office flow, reading old magazines (bad idea), waiting for your name to be called, Vitals taken, nursing history, waiting, doctor comes in, computer issues, physical exam, doctor discussion, and finally “any questions?” By this time patients are often dizzy, confused and on their way to the front desk.
Better way, First write your questions down well before you get to the office, place a context on why you have the question. Let me give you an example, “Can you tell me about headaches?” this is not a great question, but “I have a concern as I get headaches when I am exercising, is that something I should be concerned about?” Make sure you have the question in the context of your concern. And be ready to provide answers for the follow up questions. When, how often, how bad, …….
Write down your questions, they may be symptoms you are having, they may be screening , medication or test questions or they may be general health questions. Bring 2 copies of your questions, doing this in the waiting room or the exam room will not work. If you don’t write them down, I assure you that your chance of remembering them is close to zero. Write down your medications and any questions you may have about them, including side effect concerns, cost and generic options.
First thing, give one copy to the nurse bringing you into the exam room, this will allow for 2 things, one is they may be able to answer some of your concerns as they prep you for the doctor. They will also let the doctor know what your concerns are before they walk into the room to start the visit, so as a physician we are prepared for the questions and can actually address them thru the visit. The other is that you will have your copy and make sure that your concerns are addressed before you leave.
The other big thing that patients have a concern about is the insurance side of care, if you have questions or concerns, asking the practice manager is the best idea. If you have questions, call and ask for the practice manager. They should have a great knowledge of your deductible, your costs for any care. It is important that you understand the financial impact of your insurance. With the upcoming changes in the ACA it is best to stay on top of your plan and be ready for any possible changes.
A huge change in medical care that you should discuss with your doctor is who will take care of you if you need to be in the hospital. Most primary care physicians now do not take care of hospitalized patients, they transfer that care to a group of doctors we call hospitalists. A hospitalist is a physician who only cares for patients in the hospital, they don’t have a practice in the community. As healthcare has changed, so has the practice of medicine. The length of stay in the hospital has gotten shorter even though the illness required to be in the hospital has gone up. In order to be in the hospital now you have to be very sick so many physicians are transferring the care of their patients to physicians who will be in the hospital all day and night, this allows for expedited care in some cases.
Many patients are upset with this change but we all need to realize that physicians are getting more and more sub specialized and that patients in the hospital may need to be cared for by a hospitalist specialist. Many doctors continue to balance both the hospital care as well as out patient care but that number is dropping each year. It is important to have that conversation with your doctor so you can discuss it and understand the reasoning behind it while you are healthy and not surprised when you are placed in the hospital.
So the take home messages, lets use celebrity health concerns to remind us to care for ourselves. Let’s make the most out of the doctors appointment, make sure you are getting value out of that interaction and that when you leave you are smarter about your medical condition and that all your concerns have been addressed, because if they are not one of 2 things happens, you continue to worry which is not good, or your coworker, friend or family member addresses your concern with potentially really bad information.