Four Tips to Manage Your Doctor

Anyone who has read Defiant Wellness for some time is aware of my frustration with our Disease Management System, sometimes referred to as the Healthcare System.

OK, I admit that introductory sentence reveals a negative bias. But that has been my experience in the past, but things are starting to change. I have been blessed by “insiders” who have counseled me regarding my approach, thereby enabling me to influence change.

Over the past two weeks I have had a one-year follow-up with my Cardiologist and a six-month follow-up with my Primary Care Physician. Last year when I met each of them,  they were both amazed with my progress brought about by diet and exercise. But they were both aghast that a man my age would be reckless enough to do CrossFit.

Both gents were also appalled that I would do that “caveman diet”, and ignore their advice regarding “heart healthy” options like vegetable oils, whole grains, fat free dairy, few eggs, etc. They were of the opinion that by eating four slices of bacon with six eggs and bulletproof coffee for breakfast, I was playing Russian Roulette with my heart. (Update: after two years of strict Paleo, I adopted a macronutrient-based approach to diet. I reintroduced grains, increased carb consumption and reduced fat.)

So they were thrilled with my results, BUT they seemed genuinely offended that I obtained them by rejecting all their advice. Furthermore, they were stunned that I would take the advice of a few quacks on the internet, over their wisdom.

Now I reappeared six to twelve months later and they are still amazed that my results are holding fast, with minor fluctuations. They both are amazed that my EKG is excellent. They are in awe that an old man can consume a diet so rich in saturated fat and have an excellent blood profile. They are dumbfounded that a 63 year old man can consume 3000+ calories per day, and maintain his weight for two years.

The key difference between this past month’s appointments and previous ones is that I controlled the agenda. When I showed up at my cardiologist’s office I had all my discussion points on a page on my phone. I told him right up front that after he performed my EKG and measured my blood pressure, I wanted to have a frank discussion about where we were going with my care.

I began with my meds. I have been on three different pills for a period of 10 to 20 years. I reviewed the dosages and changes I had initiated on my own. I explained that since we had last met, I took it upon myself to reduce my Calcium Channel Blocker dosage from 10 mg/day to 5 mg/day, for a period of six months with no ill effects. I showed him my average Blood Pressure and Heart Rate info for that period. Then in March of this year, I began taking that reduced dosage every other day, still monitoring BP and Pulse.

I politely challenged him as to why he was still prescribing this medication. He relented and then agreed it was time to cease taking this drug. Hooray, One Down, Two to go!

My next challenge was that all these meds were prescribed after a heart attack twenty years ago, back when my stressful hi-tech sales job and a sedentary lifestyle were killing me. My career has changed. My diet has changed. My sleep has changed. And I am anything but sedentary with the influence of CrossFit in my life.

I challenged him to give me a stress test, to prove to both of us that my heart is healthy in my current level of fitness. This week, I will have a stress test followed by an echo. I am looking forward to breaking his treadmill.

Next I challenged him on why he and my PCP are targeting certain lower BP levels when a study published by JAMA in February of this year suggested treatment for hypertension of patients 60+ years of age should be considered at the threshold blood pressure of 150/90?  We had a healthy conversation on that subject as well. He was able to convince me that my takeaway from that article was based upon a personal bias and we put that issue aside for the time being, since we had just eliminated one prescription.

Tip 1 – Control Your Healthcare Agenda

If you simply walk into the doctor’s office like every other patient and do not immediately take charge of the meeting, the Doc will be expecting his typical, passive patient who simply goes through the motions, and either takes advice at face value, or who nods his head in agreement, only to leave the office ignoring everything he was told. By setting the agenda, you put the doctor on notice that you are in charge of your health, and the doctor is a hired professional.

Tip 2 – Arm Yourself with Facts

By preparing yourself with personal statistics and facts regarding your lifestyle, including diet, fasting blood sugar, blood pressure, resting heart rate, etc., you ensure that the doctor is not basing his recommendation or prescriptions on readings from a single point in time, which may have no relevance to normal trends.

If you broke your leg 10 years ago, would you accept a doctor who still treated you by insisting you use crutches? I doubt it. So why settle for a lifelong prescription of a medication? Do your research. The internet is filled with studies regarding medications, side effects, alternatives, etc. Do your homework and come prepared for an intelligent discussion.

Tip 3 – Be firm but Polite

Recognize that your doctor has been trained in his behavior by passive patients who oftentimes just want a pill that will fix their ills and permit their continued unhealthy lifestyle. You are challenging that norm, and it may be disruptive to the doctor’s routine at first. He will also find himself in role reversal, where you control the dialogue and he is reduced from authority figure to advisor. Some doctor’s may find this quite refreshing, but others may find it offensive to their ego. Beware of this, it may take more than a single appointment before this is acceptable or even welcome.

Tip 4 – Be Proactive with Next Steps

Take charge of what is next. What are you doing over the next six months regarding your health and wellness that you wish to engage your physician’s help in monitoring? Perhaps you are making a major dietary change and you want to come back in three months for more blood work to compare certain markers. Perhaps you wish to collaborate with your doctor to establish some statistical benchmarks for tracking your progress in subsequent visits.

I know most of my readers are “take-charge” types. We “Masters” athletes buck the norms. We are statistical outliers, and as such, we mustn’t let a grossly sedentary and overweight population set the standards for our healthcare. We must be as proactive with our medical professionals as we are with our fitness. We set our goals and we must surround ourselves with “can do” people to help achieve those goals.

Be Defiant! Be Well!

Note: 2017 update – I continue to tweak nutrition to match my activities, CrossFit, Olympic Weightlifting and Starting Strength. Also, as I age, now at 66 years, I pay attention to recovery, spacing out workouts and getting more sleep. 

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