flu shot

Consumption

Posted on by writenp

I find the magnitude of consumption of health care frightening, and I’m a health care provider. I’m not talking about preventative care, which I think, if anything, more people should consume.  And of course people must seek care for sickness and trauma. I am referring to medical testing and specialty care.

Medical tests such as blood work and imaging studies (x-rays, MRIs, CT scans, and ultrasounds) are overconsumed. Most health care providers, in their personal lives, are quite prudent about their own consumption of medicine in general.  We know that every test has a downside and we want to be sure the information it will provide overcomes the potential risks.

Many people, particularly those with very good insurance, think when it comes to testing, more is better. I understand that some people really want assurance that there is nothing wrong. My Spanish-speaking patients frequently ask me — “favor de chequear todo” — to test for everything – including all cancers, to get a clean bill of health.  Of course that is not possible.

Another type of excess consumption occurs when patients want to consult a specialist for the most minor of complaints, ones that could easily and safely (not to mention more economically) be taken care of by their primary care provider. Specialists are a great resource but if one sees a myriad of specialists more than your primary care provider, sometimes health care suffers. It is very possible no one is stepping back to take a holistic approach to you as a whole person, not just a foot or a heart or a GI tract.  Patients don’t always tell their PCP which specialists they’ve been to and specialists don’t always send a report, especially if the patient has not provided a PCP because they don’t need a referral.  Contrary to popular belief, providers don’t all know each other and records don’t magically get sent to your provider’s office. This is especially problematic when medicines are prescribed and there is not a complete list which would make checking for potential interactions possible.  You as the patient need to be pro-active about this, for your own good health.

While it is true referrals are a pain for all concerned, the concept of a gate-keeper for your health, i.e., the PCP, is a good one. Yes, insurance companies use the referral mandate as a way to cut costs, but the upside is that your PCP knows what is going on with your health. We can help you determine which kind of specialist to see, if warranted. Often this is not as clear-cut as one would imagine.  So even if you don’t need a referral, you might want to talk to or message us about what is going on and why you think you need to see a particular specialist.

That being said, there are some medical offerings I wish my patients would consume more of.  Screening colonoscopies and flu shots come to mind.  I sometimes have to have to push very hard for both.  Hope you got your flu shot this year – it’s still not too late. While it’s true it’s not as effective at preventing the flu as it’s been in past years, the efficacy is still around 30%.  Way better than nothing.  Plus the flu shot mitigates the severity of influenza if you are unlucky enough to still catch it.  I was very grateful for even this level of protection when I was taking care of patients with influenza last week.

Stay healthy, and be mindful of your medical consumption.

©2018 by Eileen Healy Carlsen, FNP-BC.  All rights reserved

Of Flu Shots and Z Packs

Posted on by writenp

Everybody gets sick but some get sick more often than others.  As health care providers most nurse practitioners enjoy a robust immunity bolstered by constant contact with germs and sometimes people (usually children) coughing or sneezing in our faces. There are preventative measures anyone can take to reduce your changes of getting sick.  Handwashing is key.  I make it a habit to thoroughly wash my hands as soon as I enter my house, in addition to the usual instances. Being up to date on immunizations, including a yearly flu shot is probably the second most important thing you can do. The third is lifestyle — eating healthy food, staying hydrated and well-rested.  Even if you do all these things, you could get sick.  And most of the time, unfortunately, there isn’t a quick fix.  I am amazed at the people who present with a day or 2 of cold symptoms and demand an antibiotic — usually, and specifically a “Z-pack.”  I always take the time to discuss the likelihood of a viral illness, home measures to help you feel better and the healing power of time. Many people will listen politely and repeat their request, citing that the last time they were sick, this did the trick.  I review the potential side effects, sparing no detail.  Then I usually suggest they wait for a few days, sometimes giving them a “prescription to hold” so they don’t have to come back.  We both know they are going to fill it right away but it’s my way of taking a stand for what we call antibiotic stewardship.  What’s particularly curious is these same people who are so quick to put an antibiotic into their system will refuse a flu shot because of potential side effects (very few and benign) or because “the last time I got the flu shot, I came down with the flu.”  Which is of course impossible.  It’s an inactivated vaccine.  They could have been coming down with a cold at the time of the injection (I discourage getting the shot if you are feeling at all under the weather at the time.), or caught some other virus in the waiting room.  The funny thing is, health care providers, for the most part, practice whet we preach.  We get the flu shot every year and we resist taking antibiotics unless we are sure we have a bacterial infection, which is the only kind of infection antibiotics can resolve.