Apple Tree Medicine, PLLC

Things Doctors Wish Patients Knew

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Different Types of Office Visits

When you go to see your physician at their office, your visit falls into one of two categories: "sick" or "well".

"Sick" visits are when you are there to deal with injury, illness, or a medical condition. Consultations and follow-up visits fall into this category too.

"Well" visits are for prevention and health maintenance. Yearly checkups, sports/camp/school physicals, well woman exams, and well child checks, are all examples of "well" visits during which your physician performs many tasks to help keep you healthy, like making sure you are up to date on vaccines and screening tests, doing a full body exam, discussing lifestyle choices, etc.

If you have a problem that needs to be addressed then you are automatically coming in for a "sick" visit. "Well" visits are for when you feel fine and would like to keep it that way.

Note: traditionally doctor's offices will charge different amounts for "sick" vs "well" visits based on how many problems are addressed or the age of the patient. At Apple Tree Medicine we charge the same $85 for every sort of visit. Because we are so thorough and because our "well" visits include ALL of the elements of the different types of "well" visits in a single office visit, we will be strict about distinguishing between a "well" visit vs a "sick" visit instead of blurring the two. Occasionally, Dr. Weeks will discover an issue during the course of a "well" visit. If this occurs, the new problem may be dealt with during that "well" visit or will require an additional "sick" visit depending on the situation.


Why Doctors Limit the Number of Problems Addressed During a "Sick" Visit

Most patients underestimate the complexity and level of thought required to address their problems. Doctors limit how many problems they'll address at one time because they want to actually fully take care of all of the patient's problems. When a physician attempts to tackle multiple problems in a single visit, the more they deal with, the greater the chance for errors and things slipping through the cracks. This is how important tests go undone, medications get continued for too long, and level of risk gets incorrectly estimated. It also increases the risk of the patient forgetting important instructions because too much information was thrown at them over the course of the visit. The more balls you try to juggle, the more likely you are to drop one. There is also the issue of starting new medications. If a patient comes in with multiple problems and two of them require starting a prescription, if the patient goes on to develop side effects they don't know which of the two medications is responsible and need to start from scratch. This can be avoided by handling the two different problems at different times. Physician consensus is that patients benefit the most from dealing with one to two problems per "sick" visit.


Different Types of Doctors

When most people say the word "doctor" they are referring to physicians; those who have graduated from college and then an accredited allopathic or osteopathic medical school. Yet many people are at liberty to call themselves "doctor" and are correct to do so if they have a higher education degree that counts as a doctorate.

Some doctorates require a 4 year college degree plus at least an additional 3 years of university study with a substantial amount of original research, a thesis, and other projects. Other doctorates only require a college degree and 2 years of additional study.

For example, a Ph.D. is a type of doctorate degree. So if someone gets their Ph.D. in music then that person can legitimately refer to themselves as Doctor. Other examples of professionals with doctorate degrees include lawyers, chiropractors, dentists, clergy, pharmacists, social workers, physical therapists, etc.

We have seen some people take advantage of the potential confusion over whether "doctor" means physician or that one has obtained a doctorate. We recommend looking at the letters they put after their last name/surname/family name. Each doctorate is associated with an abbreviation. For example, Ph.D. means doctor of philosophy. The only letters after a person's last name that indicate that they are a PHYSICIAN are M.D. and D.O.


Coordination of Care

When more than one doctor is involved in your care there needs to be communication between them in order for you to have the best outcome. Any time someone goes to a specialist, an urgent care clinic, the ER, or gets admitted to the hospital, their primary care physician (PCP) is supposed to be notified. While these organizations are getting better at communicating, there are still plenty of times when your PCP will not receive a note detailing the visit or ever know that you were in the hospital. If they don't know it happened they can't be your advocate in regard to it. Because of this, your primary care physician would love your help with this issue-

  • If you go to see a specialist or go to urgent care please remind them to send a note to your primary care physician.
  • Anytime a person goes to the ER and is sent home instead of staying at the hospital, they leave with the instructions to see their PCP in 2-3 days. Please swing by your PCP's office before this to sign a release of records form so they can learn the details of what happened.
  • If you are staying at the hospital please give your primary care physician a call to let them know. When you are released home, swing by the office to sign a release of records form so they can see what was done and figure out what you'll need moving forward before your follow up visit.

If the specialist, urgent care, ER, or hospital doesn't send a note then your PCP may need you to sign paperwork allowing them to get the records and it can take up to 30 days to receive them after they've been requested. While the patient will be the primary source of information for their PCP, it's important they get the records for many reasons. For example, a specialist's note can include terminology that's unfamiliar to the patient but helps clarify the patient's condition for the PCP. Often when someone goes to the ER or while they're in the hospital they wont know all of the tests that get done. Having the records ensures your PCP doesn't unnecessarily repeat tests already performed. And in all scenarios medications can be changed, sometimes in ways that confuse the patient, and your PCP needs to know exactly which were supposed to be stopped, started, and/or changed.


Different Healthcare Settings = Different Goals

We've seen many patients dissatisfied with the care that they receive in other locations because they don't realize that the different facilities have different priorities. Here is a simplified overview of three types of healthcare settings and their goals (ER vs. Hospital vs. Clinic).

Emergency Room (ER) aka Emergency Department (ED)

Goal = determine if the problem you're having could result in loss of life or limb in the next 24 hours.

If yes, then you will be stabilized and admitted to the hospital. If no, then you will be sent home. In the latter case, depending on your problem, they may provide some level of treatment or they may simply tell you to seek care for that issue at a clinic because this setting is for the treatment of active or potential EMERGENCIES.

Hospital aka Inpatient

Goal = get you well enough that you don't need to be hospitalized again for at least a month.

The hospital is where those who are very ill or severely injured, including people who have just had major surgery, receive short term treatment. If you are stable but require care for a long period of time then you will be transitioned to another type of facility. The healthcare providers in the hospital wish to get you stable enough to be able to survive being out of the hospital. If you have chronic symptoms that have not yet be investigated but are not related to the potentially life-threatening issue that caused you to be hospitalized, you will likely be told to seek care for those issues at a clinic after you've been discharged from the hospital. You should still inform your hospital team of everything just in case it is related and you don't realize it, but don't be surprised when your tingling toes and poor hearing aren't tested when you've been hospitalized for pneumonia.

Clinic aka Doctor's Office aka Outpatient

Goal = diagnose and treat injuries and illnesses that are not emergencies as well as promote health and prevention of illness and injury.

Different specialties focus on different areas but all clinics have this same general goal. For example, a cardiologist's office focuses on testing and treating heart problems and promoting choices that will help keep your heart healthy while a pulmonologist's clinic will do the same regarding your lungs. A Family Medicine office like Apple Tree Medicine looks to take care of all of you. If you have a problem that appears to be potentially imminently threatening to life or limb then the outpatient doctor will send you to the ER for further rapid investigation.


Don't be Afraid to Speak Up

If something makes you uncomfortable, say so. If you don't want your doctor to touch part of you or perform part of an exam then tell them. At Apple Tree Medicine we respect your autonomy and hope that you feel at ease communicating your wishes with us.

If you are unsure about something your doctor said, please ask for clarification. What does this medicine do? What should I avoid? What does that word mean? What should I do if....? Asking questions is how people learn and at Apple Tree Medicine we want you to be informed.


Pay Attention to the Instructions on Your Medication

Just because it's a pill or a liquid, doesn't necessarily mean you should swallow it. Some pills are meant to be inserted into your rectum or into your vagina. There are some pills that are meant to be inserted into a device which releases the medicine as a powder you inhale. Some liquids are meant to be put in your eyes, or in your ears, or rubbed on a specific part of your skin but not other areas. These are just a few examples of why it's important to check the instructions to ensure that you benefit from the medication and don't potentially hurt yourself with it.

The instructions will tell you when/how often to use the medicine. This is based on how the medicine works. There are some medicines that if you miss a dose, your body could overreact to the lack of the medicine in a potentially dangerous way. There are some medicines that will not work as well or will not work at all unless taken at the right time. If you take some medicines too soon or too often or for too long they can hurt or even kill you.

If you bought the medicine at a store "over-the-counter," reading the instructions is still important. For example, all products that contain aspirin have instructions on the bottle/box to avoid giving that medicine to children and teenagers because it can potentially cause lethal liver and brain swelling (Reye's syndrome).  

When antibiotics are prescribed, the doctor writes for a specific number of pills or volume of liquid to be given to you. You should take the antibiotic until you run out, even if you feel all better before then. If you don't finish it all, then you risk creating "superbugs" which are germs that can make you sick again but can no longer be killed by the antibiotic you were taking. Because of the misuse of antibiotics there are germs that were previously easily treated but now are killing people because these germs learned how to resist ALL antibiotics. Please do not contribute to this growing problem.

As a general rule, you should take the lowest amount of medicine that helps because the more you take, the greater the chance of side effects or harm from the medicine. In the case of a prescription medication, your doctor has already used what they know about you and what they know about the medication to determine the optimal dose to achieve its benefit while minimizing the risks. So if the medicine is a prescription, do NOT change how much of it you take without first consulting your physician.

This all sounds pretty scary but it's like many other things in life. For example, water. You need to consume it to live but too little or too much can be dangerous and if you put it in your lungs instead of your stomach it could kill you. Medications, when used properly, can be safe and extremely beneficial. If you have any concerns or questions about a medication, please contact your physician.


Sharing Medication

If you receive a prescription medication from your doctor, do not ever give it to someone else. Do not take other people's prescriptions. Both of these situations are illegal.

Why is it illegal? Because it can result in injury and/or death. A medication is a prescription instead of being available to all to purchase "over-the-counter" because of how dangerous it can be. Prescription medications are those that require a physician be involved to determine the risks and benefits of that medication for that individual patient.

If you take a prescription medication that wasn't prescribed for you, you are endangering your health and potentially your life. For example, perhaps your doctor knew not to prescribe that medicine for you because they know you have mild kidney problems and that medicine would damage your kidneys even more.

If you share your prescription medicine with someone else, they could be hurt or killed and you're legally responsible for that outcome. For example, perhaps they are on other medicines you don't know about and their doctor chose not to prescribe your medication to them because they knew it would interact with another medicine they take and potentially kill them.


Antibiotics

Unfortunately the term "antibiotic" gets misapplied to many medications. Here's what the terms actually mean:

  • Antibiotics are medicines that hurt BACTERIA
  • Antivirals are medicines that hurt viruses
  • Antifungals are medicines that hurt fungi
  • Antiparasitics are medicines that hurt parasites
  • All of these medications hurt these various types of microbes and therefore fall under the label of antimicrobial

If your illness is caused by a virus, fungus, or parasite, then an antibiotic WILL NOT WORK and can potentially hurt you by killing the healthy good bacteria that are naturally with you. For example, the common cold is caused by viruses which is why giving antibiotics to someone with a cold would be wrong to do.


The Flu

Many people use this term incorrectly. Sometimes they just have an unpleasant cold or they say that they have "the stomach flu." In truth there is no such thing as "the stomach flu." Those people are suffering from a GI ailment, potentially a virus, but NOT the flu.

The flu, also called Influenza, is caused by Influenza viruses. There are several types, and different subtypes or strains, of the Influenza virus. Influenza type A and Influenza type B cause an epidemic in the USA almost every winter and H1N1 is a subtype of Influenza A that emerged in 2009. These Influenza epidemics result in the deaths of strong and healthy individuals as well as vulnerable people of all ages. Depending on the year, the number of people who die from the flu varies but typically ranges from 13,000 to 49,000. The 2012-2013 flu season was particularly bad with an estimate of 56,000 people dying because of the flu.

Because of this, every year the CDC and researchers do their best to judge which strains of the flu will hit the hardest in the coming winter. They then make vaccines to be injected which will help to protect a person against 3 or 4 strains that flu season. These shots do NOT contain live virus which is why you CANNOT get Influenza from the flu shot. Some people may not feel well after getting their shot but this is because of their immune system ramping up to protect them from the germs it just learned about. Influenza can be in your body for 4 days prior to developing symptoms so those who do actually come down with Influenza shortly after getting the vaccine are ill because they were already infected and too late in getting the vaccine.

  • Do the vaccines always 100% protect every single person who gets the shot? No, because everyone's immune system is different.
  • Do the researchers always correctly predict which strains will be the most common that year? No.
  • Even if they're correct about which strains will be the most prevalent, will there still be other strains getting people sick that weren't included in the shot? Yes.
  • Is it still worth getting the flu shot? Absolutely. Any protection against a germ that could kill anyone is better than no protection at all.

If you wish to learn more about the flu and the flu shot, please go to www.cdc.gov/flu and/or talk with your physician.


Fever

Your body's temperature can be affected by many things. For example: the environment, exercise, and various medical conditions. If you have an infection, sometimes your body responds by increasing your temperature to the point that you develop a "fever". A fever can help hinder some germs and can help your immune system fight the infection. When your body temperature reaches 100.4 degrees Fahrenheit or higher that is when you are classified as having a fever. Even if your normal resting body temperature is less than 98.6 degrees, you do not have a fever until your body temp reaches at least 100.4 degrees Fahrenheit . While a fever can be uncomfortable, depending on the situation, you may not need fever reducing medication.


Relevant Age Old Wisdom (Translated)

"An apple a day keeps the doctor away" - eating healthy helps keep you well so you won't need to see the doctor as often.

"An ounce of prevention is worth a pound of cure" - a little effort/time/money spent on preventing illness/injury costs much much much less than it costs to deal with a problem once it's struck. For example, buckling your seatbelt costs nothing compared to losing your life or the hospital bills should you survive a terrible car crash.

"Honesty is the best policy" - the best course of action is to tell the truth. There are many times in medicine when a physician may recommend a treatment that unintentionally hurts the patient because the patient hid information from or misled the physician. For example, if a patient goes to the ER with chest pain and does not share that they use cocaine then the physician will likely prescribe a certain medication which should help the patient but in this case could kill them. We at Apple Tree Medicine thank you for your honesty and for trusting us with your personal information. Dr. Weeks may ask a ton of questions, sometimes seemingly odd ones, but every time she asks you something there's a reason for it and the goal is always so that she can do what's best for you. Every time you answer Dr. Weeks' questions truthfully you arm her with the knowledge she needs to serve you to the fullest of her ability.