Weekly Health News 03 Ask the Doctor - Your Live Depends On It

Ask doctor as though life depended on it
July 3, 2007

The book's title, "What You Don't Know Can Kill You," telegraphs
physician-author Laura Nathanson's outrage, which is the theme of this often
helpful guide to navigating the treacherous waters of the health-care
system.

Nathanson's book bills itself as "a radical guide to conquering the
obstacles to excellent medical care." It's hard to see how the notion of
gathering medical records, reading pathology reports and questioning doctors
as Nathanson recommends is radical. But given the passivity of many
Americans who typically spend more time shopping for a car than for a
hospital or doctor, maybe it is.
Her experience is tragically instructive. The book is dedicated to the
memory of her husband, Chuck, who died in 2003, less than three years after
half a dozen doctors missed or misdiagnosed his rare and initially quite
treatable cancer.

By the time the peach-size tumor was accurately diagnosed, a process that
took about two years, it was very advanced and extremely difficult to treat.
As Nathanson notes, accurate and timely diagnosis is the key to survival or
even cure.

"You cannot rely on today's medical system to keep you healthy, safe and
alive," writes Nathanson, a pediatrician, although this claim is unlikely to
surprise anyone who has recently experienced the unraveling patchwork that
constitutes the health-care system. No one, she notes, is in charge, and the
system is absurdly complicated, even for a physician.

But, she writes, "if I had taken the precautions set forth in this book, my
husband of 30 years might be with me today."

It wasn't until things had gone horribly wrong that Nathanson collected and
read his medical records, only to discover that the cancer that would kill
her husband was visible on his first chest X-ray. Yet none of the many
doctors who treated him, it seems, did an adequate follow-up.

Using her husband's medical records as a guide, Nathanson advises patients
how to avoid making similar mistakes. She defines medical jargon, highlights
words that may signal what she terms "fuzzy logic" in reasoning and
diagnosis, and tells patients how to spot red flags in pathology reports
that can seem impenetrable to all but the most medically savvy.

Patients, she advises, should ask - or, if necessary, demand - a second
opinion, or in certain cases a second biopsy.

Her chapters about how to act as a patient's "sentinel" in the hospital -
and why it's so important to have one - are sensible and will resonate with
anyone who has spent the night with a sick relative on an understaffed
floor: Help the nurses but don't get in their way; ask questions without
being confrontational; and, most important, don't be afraid to make a scene
if your charge is in trouble and your requests for help go unheeded.

Nathanson recounts one harrowing incident when she started yelling at the
nurses' station at 4 a.m., convinced that her husband was crashing, even
though his lab tests didn't look bad. He was, in fact, deathly ill, and her
yelling prompted a quick call to a surgeon who immediately inserted a chest
tube.

One piece of advice, however, borders on the bizarre. She advises those in
an erotic relationship to try to maintain it in the hospital. "Nothing is so
empowering, non-invalid and non-hospital-like as furtive hanky-panky," she
writes, "especially with the danger of being walked in on."

Perhaps. But readers will probably find Nathanson's advice about avoiding
hospitalization more useful.