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This is old hat to most of the posters here, but maybe some of the younger readers might find this helpful.
(1) The official book of United States prescription drugs that includes the side effects, doseages, composition, mode of action and cautionary suggestions is the PHYSICIANS DESK REFERENCE, also known as "The PDR". This comes out once a year and is a big book, usually about two inches thick with tissue paper thin pages. It is expensive, but drug companies frequently provide physicians with free copies every year and you can sometimes bum last years edition. Most public libraries and drugstores carry this volume. The librarys often sell last years PDR at the annual book sale for a dollar or two. If you are given a prescription you should always read the package insert, which is reproduced in the PDR. Don't depend upon the "edited" version given by many drugstores these days. This book also covers drugs by both brand name and generic name. The issue of whether a brand name is better has been debated for years but one thing is for certain - brand names of drugs are far more expensive. With the PDR you can compare and contrast brand name drugs with their generic counterpart. If you have a loved one in a hospital and they are being provided with medications there is always a PDR at the nurses station which they will almost always provide, if politely asked. This is the book to go for instead of some "gee whiz" volume on drugs produced in a condensed version by a "medical writer." This is the volume your physician uses when making a decision on your medications.
(2) The other volume everyone should have around the house (and they are expensive too) is a MEDICAL DICTIONARY. Many have discovered to their surprise the ordinary dictionary does not have medical terms. One of the best is called STEDMANS. This is available in most librarys. If a physician provides you with a diagnosis or surgical procedure recommendation have him WRITE OUT the diagnosis or procedure. Step two is to go to a medical dictionary such as STEDMANS and look up all the terms. Only then are you in a position to begin searching data bases. Incidentally, STEDMANS is now available on computer disk. A medical dictionary is a necessity to interpret many of the articles appearing in professional health care journals. There is an agreed upon term for most everything nowadays to eliminate ambiguity in medical procedures. From time to time the terms change. Without these two volumes it is impossible for a lay person to intelligently interact with a physician concerning medical care provided to your family.
[This message has been edited by newyorktwo (edited December 06, 1999).]
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Another good source now is WEBMD newyorktwo. I think that even with these two books, which are very good by the way, it is hard for most families to understand what is going on, or what we as health professionals are doing or what even the options are. I think that Nurse Red is probably in agreement with this, but I think that as an ICU nurse, one of the most important things you can do is to explain what is going on to the families. Like this weekend I had a 63 year-old person who had been fighting diabetes for 20 years, with the last 5 years being the worse. The family was VERY well informed already, but now things were getting complicated. Gangrene had set in on a foot ulcer, infecting the leg. With a bad heart with an ejection fraction of only 22%, the doctors were at a crossroads and so was the poor family and the patient. This person was also a dialysis patient as his kidneys quit after his open-heart surgery several years ago. Now, here is the question--having had a stroke many years ago--yet being so alert and oriented--this person suddenly makes a mental status change---is it another stroke, or toxins from the gangrene or another infection??? Should they operate??? I think the point I am trying to make here is that you could look up each of these problems--but how can you tie it all together? The doctors talk very quickly to the family--busy as they are--and don't really explain anything in terms anyone in the family can make sense of. It turns out that the leg was not only infected--but the patient had not one but two of the superinfections that is so talked about both in his blood stream and on his vascath or dialysis catheter. While trying to fight the gangrene--and being a diabetic--his immune system took a direct hit also, making him susceptible to infections. With all that, he now comes to ICU very septic. And that in itself is a complicated concept--the family just sees the cold blue hands (the so-called cold shock phase) and the trouble breathing and is wondering if any antibiotics are going to help. How do you give Vancomycin to a renal patient--the only antibiotic for this kind of infection? And the poor patient has a ph of 7.1, certainly not compatible with life. It was up to the nurse alone to recognize what was happening as the patient rolled through the ICU door from the floor--get blood gases--call the doctor at the same time treating the ph and get the poor unfortunate gentleman intubated before he brady-ed down and coded and the dialysis people on their way to the hospital to start immediate dialysis. Is the doctor there to explain to the frantic family what is going on? NO. But when the crisis was past and things looked stable enough, we let the family stay in the room and ask all the questions they wanted to, after giving a thorough explanation in terms they could understand about what was going on. I think that an explanation, unbiased clear and concise and with all the treatment options layed out up front is the very least a patient and his family should expect. In other words--this is what is going on and this is what we are doing about it. And you can't rush through explanations--because the family is often in shock and really can't hear alot of info to start out with. Sometimes explanations have to be repeated.
I think too, that even with Stedman's or the PDR or Mosby CDRom Interactive, or Merck Manual or whatever, it may still be hard to intelligently interact with certain health care professionals. With the advent of HMO's- the doctors may even be prevented now from giving you the straight story on anything.
[This message has been edited by RunningSoLate (edited December 07, 1999).]
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Hoo Boy! I'm on the fence about this one. I truly beleive that the general public should be more informed about medications, treatments, and diseases. However, I have often seen persons peruse medical books and convince themselves they have a particular condition they just read about. They identify with every sign and symptom. Sometimes the power of suggestion takes over and symptoms that aren't really there become imagined or exagerrated. They now present to a physician convinced that this disease or condition is running rampant in their body and insist on being treated for it. They recite all the signs and symptoms to the physician and he treats accordingly. (Hopefully he/she will do their homework and run whatever studies will determine the truth) but maybe not. All the S&S are there. No need to run the tests (a lot of HMO's discourage expensive testing anyway).
A fellow nursing student was convinced that someone in her family had every disease we studied in class. It became a huge joke.
I learned very quickly after graduating from school and beginning my tour of duty on a Med/Surg unit in the hospital that all my medical training over the last few years had taught me just enough to get my butt in a sling. Now here I was, a full fledged nurse, and all the things I had learned were still not enough for me to know or understand it all.
There was so much more to the practice of medicine that only time and experience could give me. Not to mention the fact that treatments and medications change so rapidly that what is used as standard treatment 2-3 years ago may now be outdated, sometimes contraindicated.
Also, the medical terminology that is used can be confusing. Let the layperson misinterpret one simple word or term and it can change the whole meaning of what they are reading or hearing.
Here is a prime example. This year while giving flu shots, I provide each person with a fact sheet about flu vaccine. In that fact sheet it details who should and should not receive the vaccine. One sentence states that those exposed to small children or the elderly SHOULD receive the immunization. The 'should' is capitalized and bolded, yet many persons think it says just the opposite and will decline the shot until their error is pointed out to them. No fancy medical terminology to confuse them, simple plain english and they still misunderstand.
I'm not so sure handing them a PDR and a Taber's medical dictionary is a good plan.
Nothing replaces good, old fashioned, simple explanations from the caregivers.
As detailed by RSL, the role of the nurse is often being the mouthpiece and translator for the physician. I can't tell you how many times I have seen a Doc blow into a patient's room, rattle off a bunch of medical gibberish to the patient and family, ask if they have any questions, and assume because they sit there quietly that his job is done. After the Doc left I would ask, "Did you understand what he was telling you"? Heads slowly shake and they look at the floor because they are embarrassed to admit it. I would then tell them the exact same things, in terms they could understand, then ask for questions and present the answers the same way.
Cultural and demographical differences play a big role in this as well. While we routinely throw around terms like hypertension and diabetes, (thinking that everyone knows what these terms mean) a person from a small rural area may have only heard them referred to as 'High blood' or 'The sugar'.
Here is another example of this. On the DOT exam form there is a small questionairre at the beginning that asks if you have a history of various maladies. If allowed to, the patient will fill it out and mark 'NO' to everything. Now walk the patient through that questionairre and ask those questions in layman's terms and you will find the guy who has been on hypertensive medications for 5 years will mark 'NO' to the question 'Do you have any cardiovascular conditions'?
The other side of this coin is the person who comes to the Doctor because they twisted their knee. They are having pain. They are treated conservatively at first with crutches, knee support, anti-inflammatories and x-rayed. Xray are negative and the person is sent home to heal for a few days to be re-evaluated on return. So many people will howl right away that 'their friend had this same problem and they got an MRI showing they needed surgery'. They now think the Doctor is an idiot because he/she didn't order an MRI immediately and they stop listening to the reasons's for waiting it out if the clinical signs are not there to warrant this testing.
Another example of people with too much knowledge is those who go to the Doctor with a simple cold and expect to walk out of the Drs. office with a prescription for something. Many Drs. were prescribing antibiotics (knowing full well that antibiotics have no effect on cold virus')just so the patient had a prescription for something. The line of thinking then was that the patient would psychologically feel better if nothing else, and what harm could taking antibiotics do them? RIGHT? WRONG! Look what that practice has caused. We now have a generation of bacteria that we are rapidly running out of effective antibiotics for.
My point is that this increased knowledge issue can be a Catch 22.
Picture the average person reading a PDR and under adverse reactions it lists 'nausea and vomiting' (which is listed with almost every medication in there). This person now thinks that because this medication causes them to become nauseous that they are allergic to it and will now tell medical personnel they are allergic to it. The medical person will not order that medication (even though it is clinically indicated) and resort to something less effective or one that has more serious adverse reactions.
My point is that little info can be just as detrimental as too much. And the happy medium is going to be different for every person and every situation. It is the medical professional's responsibilities to educate. And by that I mean nurses, Doctors, and pharmacists. And the education must be delivered in a manner that is specific to each individual case.
Just my 2 cents worth.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at
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Very good points raised. In the case of the PDR, I feel that anyone who drives a truck is in a unique situation insofar as responsibilities which are not percieved by most physicians. The necessity of reviewing every possible side effect of a medication, no matter how remote, is a necessity. The PDR provides such a reference. Not too long ago I was prescribed a medication, reported for work, and developed double vision. This was an ocassional side effect of the medication not considered by the doctor. Instead of taking my own advice I never even read the PDR, which I had on my desk.
The issue of a patients responsibility for their own treatment is one with two sides. I believe, however, that we are on the cusp of a fundamental change in the doctor-patient relationship as a result of the information revolution. A quantum change, if you like. It is quite possible for a patient nowadays to become more up-to-date on a specific condition that a physician. little knowledge may be a dangerous thing, but the nature of a free society entails risks. In fact most hospitals have rigidly prescribed treatment protocols for many conditions and even an attending physician who has rights at the facility has no option other than to follow the routine to the letter.
A respected friend of mine recently informed me (his wife developed a malignancy) he was looking for an "octorologist". What he really needed was an oncologist for a second opinion. The treating physician was an Indian who didn't speak english too well and that bis where the confusion started. A dictionary can be helpful simply to understand the distinctions between the various medical specialties.
As mentioned, sadly, many physicians are prohibited from discussing certain treatment options, let alone providing them. The reasons for this state of affairs are complex. It behooves a patient to avail himself of all information possible. There was a time not so long ago when physicians were "gods" and the idea was to "get the best doctor possible". My belief is that was an era of hubris. An era that is coming to an end, rightly or wrongly, like it or not.
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I have to agree with everything you say newyorktwo. Since I went to work in Atlanta--I have many family members who bring their laptops to look up things they are trying to understand. I even suggest sites they can go to. I have had some very excellent conversations with families as they try to understand what's going on. When you talked about a foreign doctor--the problem I find there is the culture difference. In alot of foreign countries what the doctor said was final--no questions asked. They have a hard time even being civil to the people they work with in trying to help a person get better. Illness involves all 4 dimensions of a person's being--mental,physical,spiritual and emotional aspects. When even just one dimension of a person's being gets effected, the other dimensions are bound to be hurting too. Cultural expectations here in the United States expect compassion, caring by health care professionals and cleanliness of the hospitals. You would be hard pressed to find any of that in hospitals today. Most hospitals just try to treat the physical while ignoring all the other dimensions to a person's well-being. Unfortunately, like other areas of our societly, greed is the op-modus of the day sanctioned by that bunch in the White House. It is just an observation, but as HMO's and managed health care have risen on the scene of health care, we now have hospitals targeted as causing the 8th leading cause of death in the United States--ahead of AIDS, Breast Cancer and traffic deaths. You never think that hospitals will kill you--only that they are supposed to make you well. Of course, Billiary is appointing a task force and we should know in no time flat what the problem is LOL right? But now I am getting off the track--ARM YOURSELF WITH KNOWLEDGE--find a nurse or doctor who you consider your friend, is knowlegeable, and can explain what's going on. READ or go to the internet. Knowledge is empowering and I would encourage it to the max.
And by the way, your post on high blood pressure was excellent newyorktwo. Do you know they make a PDR for herbs, and alternative medicine now too? We check out all the medicines a person uses, because herbs can have a synergisic effect with other medications a doctor gives a patient, or even an adverse effect. We don't discourage their use at all--but do consider them in light of the effect they can have as we mix medicines together.
[This message has been edited by RunningSoLate (edited December 08, 1999).]
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My father broke his hip a couple of years ago. So I started looking up everything I could find on the subject,Medline,Mayo Clinic etc.I kept running into these charts that showed statistics on how long a patient survives after hip replacement or how long before they need nursing home care after they broke their hip.There it was right on my screen ..Dad's a goner. X people die after 3 months etc..I was pretty depressed about it. When I told the doctor about this he told me I did not know what I was talking about.He was right. I still read them but now I know you need someone to help you decipher them also.