"People are living longer than ever before.
It’s nature’s way of helping you pay off your
student loans."

Jul/Aug 12

"Don’t lie! You’ve been scratching it, haven’t you?"

Jan/Feb 96

"Young lady, whatever possessed you to wear
glass slippers in the first place?"

Jan/Feb 96

"Your husband is improving, but he’s not out of the woods yet."

May/Jun 94

"The anesthesiologist is running late. We’ll have to start without him."

Jan/Feb 12

"Nice to meet you Mr. Holtz. Your wife told me she had married a fixer-upper."

Jul/Aug 95

Cartoons: The Doctor is In The Saturday Evening Post

“I have a few questions,” Susana interjected, stopping the pediatrician in her tracks. “What do I do for her?”

“Give her some Tylenol,” she advised. “She’ll be fine.”

“How much Tylenol do I give her?” the new mother asked.

“What is her body weight?” the doctor said, scanning Sofia’s chart.

“I don’t know—no one in 
your office weighed her or took her temperature,” she replied. “Will you please pay more attention to this situation and tell me what’s wrong with my daughter? I need information.”

Because Susana spoke up, her daughter got the attention she needed, and Susana got the information and guidance that she, as a paying customer and concerned mother, had a right to expect from the doctor. But not everyone feels comfortable doing that, even if they should.

Being wise medical consumers means choosing medical partners we can communicate with effectively and trust. When it comes to protecting our health, we have to be sure that we are getting what we pay for. An engaged, concerned, and skilled doctor is the best health care investment we can hope to find.

Illustrated by Pablo Bernasconi

Let’s Talk

Perhaps the most important step to becoming a smart medical consumer is the process of finding and choosing the right GP or family physician. That person will be your closest medical partner and will play an important role in helping you make other decisions about your health care management and practitioners. If 
you are in the market for a new physician, ask your friends and co-workers for recommendations, and go online to find out what doctors within that specialty are located in your area. When you’ve found one you want to “interview,” call the office and schedule an introductory appointment, so you can go 
in, share your medical history, and get a sense of the doctor’s attitudes and approach to medicine. (Tell the scheduling assistant specifically what 
you want to do during the appointment so you have adequate time.)

As with any interview, little things count: The office workers, nurses, and med techs should be friendly and helpful; the office should be clean; the doctor should be open and willing to talk with you about your concerns and interests. Keep it relatively simple, but use your time to determine how well this physician’s working approach suits your own. Does he or she communicate with patients via e-mail when appropriate? Is this doctor comfortable discussing information you’ve gathered? What hospital affiliations does the practice maintain? What regular screening tests does he recommend for someone of your age group? Talk about your major health concerns and listen closely to the answers you receive. If you’re comfortable with the initial meeting, schedule a full physical and use that experience to cement or break the deal with this doc.

Partner with Your Physician

Doctors are not infallible, nor should we expect them to be. Like the rest of us, they occasionally will be distracted and disengaged, and they won’t always seek our active collaboration in the doctor-patient relationship. It is therefore our responsibility to speak up, ask questions, and insist that our voices are heard when we have concerns about our treatment.

We don’t need a degree in medicine to partner with our doctors. We can start with some very simple steps. First, we should realize that our medical history is our business, not just our doctors’ “property.” Most of us know that we should maintain a list of our medications, including dosages and directions for use, along with any alternative health practices and supplements. In addition, many patient advocates advise that we keep track of our medical records, requesting copies from our doctors for our own safekeeping. That way, we know exactly what information is available to new physicians and consulting specialists—and we have the important information we need if we want to do our own research. Further, with copies of our test results in hand, we can be sure that the correct name appears on them and that there wasn’t a mix-up at the lab.

Be Your Own Records Keeper

Illustrated by Pablo Bernasconi

Every time you visit a new doctor, you’re asked to complete a personal health information form that lists family medical history, your history of diseases, illnesses, injuries, hospitalizations, allergies, and so on. You’re also asked to complete a “release of information” form, which enables your previous doctor to release health records to the new doctor’s office. With all this information floating around, you might wonder why anyone would need to keep his or her own personal health record. But, according to the American Health Information Management Association (AHIMA), everyone should do so. That way, no matter when or where we need health care, the medical provider we consult has access to a full and detailed medical history.

These records can be in written or electronic form, stored in a file folder, on a computer hard drive or disk, on a portable USB removable flash drive, or through an online service. The AHIMA maintains a Web site (My Personal Health Record, myphr.com) that offers full information about the benefits of maintaining a personal health record, along with free downloadable electronic forms for compiling one. The site has a search feature to find forms, tools, and software for storing records. Online services typically have access codes and other measures devised to keep information secure and accessible only by those you’ve authorized. Some online storage services are free, while others charge a monthly fee; check each service carefully when making your choice.

Asking Questions, Getting Answers

At some point, most of us will need a medical advocate—a friend or relative who can accompany us to our appointment or examination to help take notes, ask questions, and listen to information. If 
our doctor wants to send us on our way with a prescription, we first should ask for the drug’s name, its purpose, side effects, potential negative interaction, and so on. Then, when we fill the prescription, we need to check its accuracy before we leave the pharmacy. And we should always feel free to ask “why”: Why do I need this drug, treatment, or surgery? How else could we tackle this problem? What benefits will I get 
from this treatment plan, and what risks am I taking?

Some doctors can be prickly when they sense that their authority is 
being challenged. So how do we help make sure that our physician isn’t misdiagnosing our condition? Jerome Groopman, M.D., recommends that patients or their advocates describe to their doctors exactly what worries them most about their symptoms or condition. And ask early—don’t leave important details until the doctor is leaving the room. Groopman also suggests that patients ask questions 
to make their doctors think more deeply about their diagnosis, such as “What else could this be?”

We shouldn’t hesitate to speak up about sloppy practices, either. We can—and need to—ask whether all medical instruments, including stethoscopes and blood pressure armbands, 
have been sterilized, 
and whether we should be started on antibiotics before surgery, to help ward off post-surgical infections.

Illustrated by Pablo Bernasconi

Patient-Physician Compatibility?

Through the years, my expectations for physicians have changed. If you’re going to need ongoing service, such 
as from a cardiologist, dermatologist, internist, or gynecologist, then compatibility is much more important. On the other hand, if you’re seeing a specialist for a (hopefully) one-time treatment, such as an oncologist or surgeon, personality is not as important. What you really want to know is, “How good is the doctor for this type of treatment?” A good question to ask in the first meeting is, “What is your success rate?”

I firmly believe it’s important for patients to be accountable for their bodies and health. We are in a professional relationship with our physicians. We may form close bonds with the health care teams that tend to us or our loved ones, but we can’t afford to overlook potential warning signs simply because we like and trust them. Mistakes happen all the time. Better that we ask why an order has been changed, why a vital sign has been altered, why a medication has been dropped or started, than to have a simple slip-up go unchecked and develop into a fatal error.

Primary Concerns The Saturday Evening Post

As uninsured ranks grow and insured employees cope with complex health plans with varying copays and coverage options, people struggle with understanding their bills and detecting potential errors. But help is available from a growing cottage industry of health advocates and firms specializing in reviewing medical bills; discovering mistakes; and negotiating with health care providers, insurers, and collection agencies, reports Barb Berggoetz in her Sep/Oct 2010 Saturday Evening Post article “Decoding Your Medical Bills.”

Here’s how to contact the medical billing companies mentioned in her article and take control of your health care costs:

1. Medical Billing Advocates of America

PO Box 1705
Salem, Virginia 24153
billadvocates.com
540-387-5870

2. MedReview Solutions, Inc.

4840 Willow Ridge Court
Zionsville, Indiana 46077
medreviewsolutions.com
317-873-4872

3. Chapman Consulting and Hospital Bill Review

14604 Mansfield Dam Ct Unit #1
Austin, Texas 78734
hospitalbillreview.com
800-906-8085

4. Health Advocate, Inc.

3043 Walton Road, Suite 150
Plymouth Meeting, Pennsylvania 19462
healthadvocate.com
610-825-1222

Decoding Your Medical Bills The Saturday Evening Post

For the nearly 50,000 Americans seeking relief each 
year for debilitating bone-on-bone ankle pain and disability, there’s good news. Recent advances in arguably the 
most intriguing area of orthopedic surgery—total ankle replacement—are making strides in restoring mobility and quality of life to patients.

Today, four total ankle replacements are used in the U.S.: the Agility, the Inbone, the Salto Talaris Anatomic Ankle, and the Scandinavian Total Ankle Replacement (STAR).

“The technology is light years ahead of where it was a decade ago,” says Dr. Robert Anderson, an orthopedic surgeon in Charlotte, North Carolina, who performed more than 40 Inbone procedures in the past two years and is part of a design team working on a second-generation device.

Hi-tech artificial ankles provide a new alternative to surgery, which permanently fuses worn-out joints. That procedure reduces ankle pain but often limits mobility, causes a limp, and can lead to arthritis in nearby foot joints. An estimated 25,000 Americans underwent ankle fusions in 2009; others considered even more drastic measures.

Reasons for needing an ankle replacement include wear-and-tear over time, accidents, sports injuries, and bone diseases that lead to severe and life-limiting arthritis.

Four years ago, Jeanne St. John’s ankle problems led her to the brink of a difficult decision.

“I was born with deformed ankles and, eventually, was 
so immobilized by arthritis that I considered a double amputation,” recalls St. John, who lives in Oregon. “Then a friend heard about the Inbone. It’s been life-changing for me.”

As with hip and knee replacements, the history of total ankles dates back to the 1970s. Healthy ankles can withstand 1.5 times one’s body weight while walking, but early devices didn’t hold up. Then, Dr. Mark Reiley—who performed St. John’s surgeries in the San Francisco Bay Area—devised a new way to replace the complex joint.

“Dr. Reiley took the proven technology of knee replacements and basically flipped it upside down to be used in the ankle,” Dr. Anderson describes. “The device, now called the Inbone, has very good mechanical advantages and can be used for primary replacements, as well as revisions of failed or previously placed devices. We believe it will be successful 
for a long time.”

Orthopedic surgeons select the specific ankle replacements depending on patient age, anatomy, bone quality, and goals. Long-term success rates on Inbone are not yet available; European data show that 85 percent of modified Salto and STAR devices are functioning well after 10 years.

But Jeanne St. John, now age 67, prefers to focus on how far her new ankles take her.

“I think in terms of steps rather than years,” she says. “I save my steps for selected activities and for travel. Some of my friends are slowing down, but I have this ‘reverse aging’ thing going on, and I’m so thankful.”

Good News for Bad Ankles The Saturday Evening Post

Mark McEwen, former TV weatherman for The Early Show on CBS, found out during a flight to Orlando in 2005. He had been dozing, then woke up, feeling odd. “It was like being underwater and trying to swim to the surface,” says McEwen, now 55. “You’re just trying to survive, to make sense of something that is senseless.” He had no clue it was a stroke. Nor apparently did the attendant who helped him off the plane—or the skycap who left McEwen sitting curbside in a wheelchair. McEwen could barely talk, but he did manage to ring his wife’s cell phone and convey a basic message. “Help me. Not good.”

If someone near you, like McEwen, were having a stroke, would you recognize it? Would you know what to do? Stroke is the third leading cause of death in this country—and every 40 seconds on average, someone in the United States suffers one. About 30 percent of strokes 
are mild, resulting in no disability. But the 20 percent that are severe, yet survivable, can be crippling.

“A major stroke can change everything—the ability to speak, to move, to work,” says Dr. Walter Kernan, professor of medicine at Yale University School of Medicine. “It may seem to rob a person of his life without actually taking it.” Fortunately, new therapies are in the works that may help improve outcomes.

Striking Out Against Stroke

The most significant advance is the clot-busting drug, known as tissue plasminogen activator, or tPA, which can help the 85 percent of patients whose strokes are caused by clots in the brain. “Sadly,” says Dr. Ralph Sacco, a neurologist and president-elect of the American Heart Association (of which the American Stroke Association is a division), “only about 5 percent of patients actually get it because they don’t reach the hospital in time or they don’t go to a [hospital certified as a] primary stroke center, which can give it rapidly.” Administered intravenously, it takes time to dissolve a clot, particularly a large one and as neurologists say, “time is brain.” Last year, the AHA revised its guidelines, saying that tPA could be given up to four hours and 30 minutes after the onset of stroke—a significant increase over the previous three-hour window. But sooner remains better.

“The best outcomes are still in patients with small clots who receive tPA in less than 90 minutes,” says Dr. Rishi Gupta of Vanderbilt University Medical Center.

Other technologies are already available at comprehensive stroke centers (a notch above primary stroke centers, which are mainly geared to giving tPA). At the Cleveland Clinic, doctors are using stents to prop open blocked blood vessels during a stroke, as well as two FDA-approved devices to help remove clots. One, the Merci Retriever, works like a miniature corkscrew to pull the clot out. The other, the Penumbra, breaks up a clot with microjets of water, then suctions out the pieces. Both devices require highly skilled specialists, and not every patient is a candidate. “You have to image the brain first to see if functional tissue remains that could benefit from restored blood flow,” says Dr. Irene Katzan, medical director of the stroke program at the Cleveland Clinic.

Refining Recovery

Acute treatment is only the first step in stroke recovery. Fortunately, therapists are getting better results with post-stroke rehabilitation than ever. “We used to say to patients, ‘you have three to six months to improve, and after that you can’t expect a whole lot,’ ” says Dr. Richard Zorowitz, chair of physical medicine and rehabilitation at Johns Hopkins Bayview Medical Center. Now, knowledge about the brain’s ability to rewire itself—a concept called neuroplasticity—has encouraged therapists (and patients) to try longer and harder.

“Thanks to the neuroplasticity of the brain—the ability of the brain cells to rearrange their connections, our brain has more capacity than we ever imagined to rewire itself for greater levels of recovery,” says researcher and stroke survivor Dr. Jill Bolte Taylor (read “Life After Stroke”).

Dr. Steven C. Cramer at the University of California, Irvine, is working with robotic therapy to help restore function as well as investigating two hormones that may encourage stem cells to develop into new neurons, key cells that transmit nerve signals to and from the brain. So far, early results look promising. Meanwhile, Dr. David Simpson at Mount Sinai School of Medicine in New York is using botulinum toxin (Botox) to help reduce the spasms that lead to twisted limbs and abnormal gaits, a frequent result of stroke.

For the most part, rehab consists of hard work—and lots of it. Three hours a day is the rule of thumb. But technologies like Nintendo’s Wii video game console keeps exercises interesting—engaging stroke patients in games such as bowling or tennis to improve balance and shifting of weight.

As for McEwen, he’s back on his feet after 14 months of rehab. Today the former weatherman, who described his experiences in his 2008 book Change in the Weather, is a motivational speaker and spokesperson for the American Stroke Association. The organization’s latest campaign (PowerToEndStroke.org) is directed at people with risk factors for stroke—high blood pressure, diabetes, excess weight, and a history of heart disease. “There are lots of things you can do to lower your risk for stroke,” says McEwen. “Knowledge
 is power.” And it could just save your life.

The Post Investigates: Stroke Advances The Saturday Evening Post