Medical Record Retrieval

Today I reorganized my medical records. I started getting copies of them when I was in college. It was at this time that I was diagnosed with a medical condition that required surgery for a cure. That is pretty shocking. I decided that after several years of doctors’ testing and untimely diagnosis I must see what is being written about me.

By getting a copy my medical record from that doctor, I was more informed. Thereafter I continued to get copies of my medical records including blood tests and all other tests as well as surgery notes. I also started doing it for my parents and my whole family. Your medical record is the cornerstone and foundation of your medical care. It is the most important communication aside from direct patient to doctor conversation.

It sure would be nice to write it all down. The doctor writes, types, or dictates as much as possible. This important conversation including what is found on the physical exam, the diagnosis/ diagnoses, an assessment of tests done, and a plan for treatment is documented by writing, typing, or dictating. That is a lot of information to document. Accuracy is of utmost importance. The medical record is the communication tool used by all your health care providers.

It is only right that you should be able to see your medical record about you. Checking for accuracy and information in your records is important. It is empowering. It makes you want to take the best care of yourself, and be able to talk more openly to your doctor about it. I have found this to be true amongst patients that keep their medical records. I have seen medical errors avoided. I have learned more from patients about their own medical conditions because they read about them.

The best way to obtain your medical record is to obtain a record release form. Your doctors’ office should have this document. Ask for it. After completion return it to the person in charge of medical records at the office, hospital, or other medical care facility via mail, fax, or in person. A copy of the medical record is sent directly from the office, or it may be sent from a company that sends out medical records. How this is done is beyond me especially when the company is in another state. Getting the record directly from the health care provider seems easiest for the patient.

Sadly, you may have to pay for your records. It is best to get copies from your doctor at the time of your visit. Most doctors have it finished by the time you leave. When tests are ordered, the results can be faxed or mailed after your doctor talks to you about the results. This may avoid costs, and help ensure timely follow-up. I have found some doctors’ offices automatically give you this information. How nice!

Medical record retrieval can be challenging, but rewarding. Keeping current with your health is your job. You are your most important asset.
Information on obtaining a medical record release form can be found at http://www.mypatienthandbook.com/ under “Patient Tools”. Then reconnect to the blog spot. Happy blogging!

Prevention Guideline Changes

Should we follow preventive guidelines recommended by a single source, or by our individual medical history? I heard on the news this week that the USPTF (United States Preventive Task Force) no longer recommends screening for prostate cancer with the PSA (prostate specific antigen) blood test in men aged over 75. I was shocked to hear that a few years ago it discontinued monthly self breast exams (SBE).

These are easy, cheap ways to screen for cancer. The breast exam you can even do yourself. For those who are unable to get mammogram the self breast exam can be helpful. As for the PSA it is felt that men usually don’t live much longer than 10 years after turning 75. In addition, it is felt that the cancer grows so slowly that the cause of death will be from something else. Then there are the side effects of cancer treatment in someone over 70.

This type of age discrimination in health care occurs much earlier, in the 60s. If you get too many illnesses too young in life, health discrimination may be seen earlier. Women have faced this forever. We are guesstimated to live longer lives these days, into the hundreds. Why stop screening for age, sex, or chronic illness? When we choose to do so, will the system allow this without extra cost to us for life saving tests that are so cheap? Bottom line – human individuality deserves custom made prevention plans based on personal and family medical history.

See the previous blog here (5/14/07) entitled “Missed Diagnosis”. Cancer is the most missed diagnosis! Cancer prevention tests are outlined in this blog. Decide what’s best for you and discuss it openly with your health care providers. Ask them what they would do for themselves. It is very important for us to learn as much as possible about wellness, disease prevention, and disease management.

Preventive Testing Lifestyle Change

Do lifestyle changes (like proper diet, low weight, exercise, avoidance of tobacco, etc.) really keep the hypertension and high cholesterol under control if it runs in your family? Genetic disposition to diseases is tough to beat. My own health issues that have been inherited have been resistant to my ongoing 30 year regimen of proper health recommendations - and new ones are popping up earlier than in my ancestors. My cholesterol remains high, and now high blood pressure is staring me in the face. Medication has been required as I continue to do all the other right things. Has this happened to you? Please blog with me about it.

As a physician in training I recognized that prevention also includes routine checkups , and screening tests. When you get a heart scan that shows heart disease, or a self breast exam that turns up a lump, or a prostate blood test that shows cancer, you usually get more testing and treatment. It seems as if checking yourself routinely before disease that you know runs in your family is the best and right thing to do. Is it? What if something that doesn't run in the family shows up? Early detection can very critical. You can be cured and your quality of life can be better.

If you are at risk for some disease whether or not it is inherited, why not check for it early? This brings to mind the recent news about the rise of AIDS and HIV in the world. I think everyone should be checked for it. After all most routine blood tests include a syphilis test. Society has made individuals "afraid" to be HIV positive; therefore, the secrecy surrounding this makes people less likely to talk about it let alone be honest about it.

Wake up world! Get checked for everything you possibly can that is available. It's your life. To those lifestyle changes like weight control, exercise, proper diet, etc., add routine total body checkups.

Ideally, your health care provider should be helping you. Help yourself and your health care provider by reading "Patient Handbook to Medical Care: Your Personal "112 page" Health Guide". www.mypatienthandbook.com. Preview pages at www.books.google.com. Information on routine physical exams, and preventive tests are detailed. Make this another lifestyle change to improve your life.

Great health is true wealth! Best health, Dr. Joan

Heart Disease Screening

EKG? Stress test? Echocardiogram? Nuclear stress test? Angiogram? CT scan? Which test is the best for checking for heart disease, also known as coronary artery disease (CAD)? The best way to look at the heart is directly. Short of an autopsy, there is no other way. So what do you do?

Thanks to modern medical technology a electron-beam computed tomography (EBCT) scan (also called fast CT) of the heart is able to show heart vessels coronary artery calcium (CAC), hard plaque that causes blockage. An angiogram/ cardiac catherization shows actual blockages. This is invasive requiring injection of dye into a main artery to view the coronary arteries, and is the gold standard for detecting CAD. The heart scans are noninvasive, and give a rather good look at CAC (hard plaque) in heart vessels which can also be a predict cardiac events like heart attacks.

The most current consensus document (2007) from the American
College of Cardiology Foundation and American Heart Association does not recommend the scan for asymptomatic people with a high risk of coronary artery disease, or for those at low risk, nor as a screening tool. It is considered reasonable in the asymptomatic with intermediate risk, and for the symptomatic person prior to an angiogram for definitive diagnosis.

The document also cites studies that compare fast CT with EKG stress test, nuclear perfusion scan, stress echocardiogram and angiogram. "The accuracy of fast CT was significantly higher than either treadmill testing or technetium stress in the diagnosis of obstructive CAD." Other studies included angiography (the gold standard), fast CT, EKG, and nuclear (with thallium and technetium) exercise stress testing. The fast CT correlated closer with the angiogram than the other tests especially if the CAC score from the fast CT was over 100. If arteries are occluded more than 50%, this will likely show on the fast CT. "Three studies have documented that CAC is a rapid and efficient screening tool for patients admitted to the emergency department with chest pain and nonspecific electrocardiograms."


So why are cardiologists continuing to pass on recommending the fast CT? Is it because it is more convenient for the doctor to do the other tests because they are more "readily available" like in the doctor's office or nearby hospital? It seems like a fast CT could be just as "readily available". Do they get paid more for these other tests that may yield less information like the specific areas where CAD may be localized?

The fast CT sounds too good to be true. Is it? Does it give more accurate information about heart vessel blockage in 10 minutes than the other tests mentioned, excluding the angiogram? I have been watching my vessels with fast CT for about 5 years now. I felt that my family history of heart disease and my risk factors warranted more than an EKG or stress test which have also been done. Both failed to correlate with the findings of the fast CT.

Tips for Medication While Traveling

When you prepare for a trip, one of the most important things to pack is your medication. Here are some tips for getting your medication organized and ready. Start at least two weeks before your trip.

1) Put all of your medication in front of you. This should include your prescribed and over the counter medications.

2) Check each prescription medication for number of refills.

3) Contact your pharmacy. Call the medication in that have refills, or fill them at the pharmacy's website. Pick up these medications, and any over the counter medications you need.

4) Contact your doctor for those that need refills. If you have not seen your doctor in three or four months, it is likely that you may have to make an appointment to see your doctor to get your refills. Your doctor's office will let you know when you call them. Make sure they have the correct phone number for your pharmacy.

5) Make a list of your medication. A medication list form can be found at www.mypatienthandbook.com under "Patient Tools".

• You can write your medication list on paper, or type on the computer and print.
• Include the name of the medicine, strength, and how many times a day you take it.
• Take a copy of this with you on your doctor visits.
• Update it monthly, and when you have medication changes.
  
  6) Buy pill reminder boxes with the days of the week on them, or use clear resealble plastic bags (sandwich size). You can buy weekly or monthly boxes. Some have midday dose sections. The easiest to use is weekly.
• Get a different color for morning, noon, and night. If different colors are hard to find, buy what is available.
• You will be able to make a label for the times of day and put on each weekly pillbox or bag.
• Make a label for "morning", "noon", and "night".
• Use adhesive labels, or write labels on piece of paper, cut out and tape to bag or pillbox.
  
  7) Put all of your most recent medication bottles from the pharmacy that are in original bottles in a plastic container with a top. This is your master pill box supply.
  
  8) Fill your weekly pillbox containers by morning, noon and evening once a week on Sunday. Put this set of pillboxes in a bag that seals. This will make it easier to see your pillboxes. They may also be packed in your special travel bag for your medical needs. Pack in the piece of luggage you will have closest access to such as purse, overnight bag, etc.
  
  9) Take your master pillbox with the original medication bottles in your luggage with your clothing, or where you choose to be the safest and most easy to get to for use.
  
  10) If you have empty used bottles from the present year that you are currently taking, put these in another master pillbox. Store this in a safe place in your home. It may be prudent to keep at least a week's supply in these bottles. This box should match the contents of your other master pillbox for travel.

By following these organization techniques, you will find that keeping up with your medication when traveling, or faced with emergency situations will be much easier.

Enjoy your trips! Great health is true wealth!

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