How to Become a Proactive Medical Patient
Schizophrenia patients could tend to die young from heart disease, or develop other health problems such as diabetes and overweight, because of our psych meds. Not only that, a lot of us don't receive quality healthcare. I'm going to use my experiences as an example of how I turned things around by becoming a proactive medical patient. I'll also give you suggestions for how to speak up in an assertive way to get the treatment you deserve. (Forgive me if I go off on a tangent about the dangerous habits that contribute to our poor health.)
"Sweetie," Dr. Krall wrapped up my first visit, "I'm going to test your blood every three months."
She wore a turquoise necklace that was in subtle good taste, so I intuited I could trust her. My Aunt Rose had been seeing this M.D. and recommended I start going to the office, too. I'd become alarmed at the treatment I received from my former primary care doctor, a man I'll call Dr. Fox, who I saw when I lived on the Island.
One Tuesday morning eight years ago, I was so fatigued I couldn't get out of bed, barely able to crawl to the phone to make an appointment. When I did go in for blood work, his office never called with the results. Two weeks later, I was still able to blow-dry my hair only from a seated position, and I lacked the energy to cook dinner when I got home from work.
One morning, I was on the subway standing near a pole, and I was so physically wrecked that I started crying uncontrollably. A silver-haired man offered me his seat. A woman turned to her friend and said, "It must be sad when life gets like that for you."
So I called Dr. Fox's office, and the assistant said, "Oh, I'll get your chart. Let me see. You had mononucleosis." This wasn't the end of his shenanigans. I had another bout of fatigue after I moved to Brooklyn, and he prescribed OTC iron pills. Something happened, I don't remember what, but I do know my mother had enough, rang Dr. Fox and exclaimed, "You're taking advantage of my daughter because of her mental illness."
After that, I couldn't possibly continue to see him, so I checked around and my aunt told me, "Go see Dr. Krall. If you don't mind her no-nonsense demeanor, you'll get the best service."
Indeed, when I saw her that first time, I told her I'd requested the last five copies of my blood test results from Dr. Fox, and they indicated I was at the highest risk for coronary artery disease, because I had an abnormal CRP (C-Reactive-Protein). That's when Dr. Krall drew my blood and told me to come back in three months.
The next night at nine o'clock she called to tell me the results, and confirmed my thyroid was sluggish, and I had an inflammation of the arteries. "Take one 81 mg. adult-strength aspirin each day. Get the thyroid complex in the Vitamin Shoppe. I won't yet prescribe anything for it because I want to see how it goes."
All told, I've been seeing Dr. Krall for seven years now. After I saw her on April 19th, before I went to Boston, she told me my CRP was wacky again, my HDL was too low at 44, and my thyroid was sluggish, too. My blood sugar was 112, at the prior visit it was 94, and it's supposed to be below 100. The prescription? "Less sweets, more exercise."
Though I'd been exercising since March 22, I took her up on the offer and continued to go to the gym, and reduced my sugar intake measurably, so that when I next saw her on May 24, the results turned out okay. She had wanted to see me in five weeks, not three months, because the prior numbers were out of line.
When I came home at 7 p.m., my answering machine was blinking. "Sweetie, everything's fine. Just see me like we originally scheduled for July."
Too often, the meds cause weight gain, diabetes and heart problems, yet certain things are under our control. I've been exercising for three months, and eating mostly healthful foods. I couldn't ever live with myself if I didn't do this.
Though it's hard for a lot of us to get going, the pharmaceutical companies tout the atypicals as effectively working on the negative symptoms, such as lack of motivation. Is this true? If so, why are we too often resistant to Dr. Krall's advice, "less sugar, more exercise?" How come it's so hard to do what's in our best interest?
It also stumps me why so many of us imbibe sugary soft drinks. What's the allure? One time I invited a (now ex-) friend to dinner. She poured herself some Coca-Cola, and realized I chose skim milk. "You're drinking skim milk?" This woman questioned, as if I'd committed a heretic act or was at least childish or weird. Let me tell you: overweight women get osteoporosis, too, and it's because they don't have calcium in their diets. Not only that, the phosphoric acid in colas robs the body of its ability to absorb calcium. Diet soft drinks, with Aspartame, get you hooked on sugary tastes.
Do you know: I don't drink soft drinks. At the cafe where I attend the poetry reading, I have a "club soda and cranberry" once a month. When I go to restaurants, I drink only water. I haven't died from toxic tap water yet, have I?
That's the beauty of the schizophrenia: it's a highly treatable illness, one that we can control if we exercise, eat right, take the meds, socialize and get active in the world.
I'm proud everything's okay with the new blood test results. One thing bothers me, though: the persistent statistics that mental health patients receive substandard health care. How can that be? It does distress me that not too many of us have a Dr. Krall in our lives.
To close out this blog entry, I'll list some ideas I have for taking control of your health and getting the best possible treatment:
1. Ask someone who's in good health for a referral to her medical doctor if she's pleased with the treatment. Tell the new doctor so-and-so referred you.
2. See your M.D. for a yearly check-up and wellness visit. When I was in my 20s, I only went to the doctor when I was feeling sick, and that's not good.
3. Develop a relationship with a professional who will take the time to do preventive medicine before something comes up that you could be at risk for.
4. Write down a list of questions you want to ask when you go in to see the M.D. Bring a pad and pen so you can write down the answers.
5. Get photocopies of your test results to have on hand, yet know that it's all in how your doctor interprets the results. She will have the latest information about what the numbers actually mean. If something doesn't seem right, speak up and get clarification, ask if you should be doing something to address the issue.
6. At the beginning of the appointment, tell your M.D. you have questions. Waiting until you're about to leave to spring a "doorknob" on her will only try her patience if she has a long list of patients for the day and is expecting a speedy end to your visit.
7. Use Google to find free profiles of medical doctors on the Internet. Type in the words doctor profiles Florida, or whatever state you're in. At your local public library you'll find the ABMS Directory of Board Certified Medical Specialists.
8. Steer clear of using the Internet to diagnosis yourself. Different problems could have similar symptoms. Unless your doctor has verified you have a certain condition, ask her if it could be something else, or if anything doesn't fit with the diagnosis. Sometimes the root cause isn't clear. A good M.D. will examine the possibilities.
9. If you're on an atypical that causes weight gain, diabetes or heart problems, and you're not aware you have any of these concerns, be proactive. Ask your primary care doctor what you can do to continue to ward off these conditions.
10. Speak up! If you assert yourself, your doctor should be impressed, not affronted. If she balks at your strategy, maybe it's time to find the M.D. who will listen
*These 10 tips will be included in my second book, the self-help guide Life Will Tell You: On Living Well with Schizophrenia