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Medical Matters

There is no doubt that as we age we are faced with more and more medical issues. These can be chronic conditions like osteoporosis and arthritis that affect mobility, or life-threatening diseases like cancer. Understanding how to help your parents cope with their illnesses will bring you both better peace of mind and quality of life.

• (New!) 9 Ways To Reduce The Spread of Hospital-Acquired Infectious Diseases

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• No More Missed Meds

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• Getting Smarter About Medication Management

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• Hearing Problems In Seniors: Tinnitus

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• Vertigo and Preventing Falls Among Seniors

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• Understanding Voice Disorders in Seniors

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• 9 Steps To Surviving A Hospital Stay

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• Dehydration: A Hidden Risk to the Elderly

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• Dealing With Vision Loss in Seniors

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• Bedwetting Alarms Can Help Improve Urinary Continence

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• Understanding Urinary Tract Infections in the Elderly

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• Determining the Causes of Urinary Incontinence

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• Eight Common Ailments We Develop as We Age

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• Living with Neuropathies

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• Living with Arthritis and Arthritic Conditions

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• Living with Macular Degeneration

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• Living with Congestive Heart Failure

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• Living with COPD

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You're right to check whether doctor knows best

By Miriam Stoppard on Sep 7, 09 12:52 AM in Today's Health Topic

I'm a big believer in everyone's right to a second opinion in medical matters. As far as I'm concerned, two heads are nearly always better than one.

But, as lots of letters I receive reveal, many people are terrified at the thought of questioning their doctor. In fact, latest figures show half of all patients don't bother to seek a second opinion - even when they have serious concerns about their diagnosis.

Taking charge of your health With something as serious as cancer treatment or a heart-bypass operation, having the input of another expert is good sense.

Most doctors would agree with me. When you're having your car repaired, if it sounds too expensive or you doubt their expertise, you'll take it to another garage for a different viewpoint.

Surely your health it worth the same degree of care?

So, although the NHS does not guarantee you a legal right to a second opinion, if you're genuinely concerned you should not only ask for one, you should stand your ground and make sure you get one.

Good reasonsto ask for a second opinion..
/ If you don't get along with your doctor
/ If you have serious doubts about your doctor
/ If your doctor dismisses your complaint as trivial but you're still concerned
/ If you are dissatisfied with your doctor's explanation of your symptoms
/ If your doctor says nothing more can be done
/ If your doctor has reached the limit of his or her expertise and it's time for specialist input - this is why we have a referral system
/ If you'd simply prefer to hear another medical opinion before you take the plunge when it come to a serious treatment - for example, when considering cancer care

How to get it

Try another GP If you don't need a specialist opinion, but simply want the view of another GP, just make an appointment with a different doctor at your practice.

Most surgeries now have their own website so it's worth looking online to find out the names of other doctors there and what their areas of special interest are.

If your health problem is related to family planning, for example, you may find a different doctor in your practice has a lot of experience in this area. Then simply book yourself an appointment with them.

If your practice doesn't have a website, the receptionist should be able to give you a leaflet with the relevant information.

Another option is to ask for the opinion of a GP outside your practice but this usually means either registering at a new practice or paying to see a GP privately.

Ask to see a specialist
You can't get a second opinion from a specialist on the NHS without a GP referral so the first step is to talk to your doctor. Explain that you still don't know what's wrong or you're not responding to current treatment and ask to see a specialist in this area - most doctors will happily refer you on.

Do a little research before you go, so you know the correct name or "ologist" to ask for - for example, a dermatologist (a skin specialist) or a gynaecologist (an specialist in women's reproductive health). If you're nervous about challenging your doctor, take someone with you - a pushy friend or, better still, your partner.

Unfair though it might be, research shows that women get better results and are given more information if they take a man with them in this situation.

Still not happy?
If your GP refuses point blank to refer you to a specialist for a second opinion, or if you're unhappy with your treatment, you do have a right to complain.

First, ask about the complaints procedure in your GP practice and follow that.

If this doesn't produce a satisfactory response, you can contact the GP council in your NHS Trust area and explain you want to be referred to a specialist but your doctor has refused.

You can also contact the Patients Association for advice (visit www.patients-association.org.uk).

When to stop
Although you have the right to a second opinion, there are times when you should accept your diagnosis...
/ If your doctor's refusal to refer makes sense
/ If your doctor explains that he feels referring you will simply put you through unnecessary tests and investigations, which are unlikely to reveal anything helpful and only cause further worry, it's probably with good reason.
/ If all opinions you hear sound the same
/ While a second opinion and possibly a third can be useful, if you're craving a fourth viewpoint it's time to stop. If three doctors have come up with the same diagnosis, it's probably the correct one. And, if several doctors have failed to find anything wrong, you should feel reassured and put to bed any nagging worries.

species

There is a paradox about science broadcasting. Surveys going back to the Jurassic will tell you it tops the favourites list of viewers, listeners and readers. They want lashings of medical matters, wildlife unleashed and science unlimited: from Big Bangs to nanotubes. Yet science on air is almost unknown outside a few public broadcasters such as ABC, SBS, BBC and CBC. Do the commercials not want this source of guaranteed ratings bonanzas? Or is something else going on?
A clue is Channel 7. Recently it brought back Beyond 2000, originally invented by the ABC, and immediately scored big audiences: 1.3 million, fine for Australia. Yet, after only two seasons, it's gone. Why?
The answer is that science journalism, like science itself, requires investment both in time and money. Without research, experience and a critical mass of qualified journalists the show quickly collapses. Public broadcasters, until recently, have been willing to pay the required bills. Now, just at a time when the world faces monumental problems requiring scientific answers, the field is on its knees.
There are two reasons for this.
First, one is attacked personally for having some kind of high profile and for trying to face general questions beyond the detail. Take Robert Winston, professor of medicine and presenter of several TV series. He says, 'It was a serious issue for me. When I started doing television on a big, popular scale, I was completely ostracised by my colleagues and it was really unpleasant. So much so that I was determined to give up doing television. I thought, this is not worth it...'
Some of us are delighted he persevered.
Second, despite what seems like public recognition (I am supposed to be a ‘Living National Treasure' for God's sake!) the reality is slim pickings. I do three programs a week on national radio, 52 weeks a year. What kind of resources might be needed to maintain such an output? Researchers, reporters, locums on stand by? The answer is zero. I have one full-time producer working on The Science Show and part-time producers for the other two shows. The odd freelancer provides an occasional report. That's it!
By ABC Radio standards I'm treated well. Imagine what it's like for my colleagues. So why put up with this? Because, without maintaining the airtime for scientific ideas, these windows too, would close. We have repeatedly warned that veterans such as Norman Swan and me (with 60 years of broadcasting between us) will not go on forever and need youngsters hired to succeed us, but the response has been Siberian.
Could science on air go extinct? Well, the ABC Natural History Unit, where we made Nature of Australia and Wolves of The Sea, closed in August. For many years it had no production budget. The ABC's ‘standing army' of TV staff, with no programs to make, has long been an embarrassment. Outsourcing may free up funds, they say.
But where will the expertise come from? The point about public broadcasters is that, from David Attenborough to Adam Spencer, from Norman Swan to Jonica Newby on Catalyst, they provide a thorough training ground for both skills and innovation. This may and does happen outside as well, but does anyone really know how much we can rely on the independent sector to take over this role? Whenever I look around Australia for young and willing science communicators ready to grab the baton I'm left floundering.
Meanwhile, in a way, we are being set up to fail. The work expands relentlessly, as ‘platforms' multiply and more, much more, has to made of your material, on webs, nets, blogs and co-pros.
As for my own books, slim as they are, they have to be done on the run, usually in a handful of weeks.
I was dumbfounded the other day when a commission I had received from an academic source, a book review I had done of a biography from America, came back asking for page references. This was over 18 months after I had sent it in, bang on the stated deadline. Can those dons really need as much time as an elephant's pregnancy to cope with each small opus?
Oh such luxury!
There is a third impediment to writing popular science with global or futuristic implications. Personal attacks. I once asked Jared Diamond at his office in Los Angeles how he dared do portmanteau works such as Guns, Germs & Steel or Collapse. He replied that he had completed his lifetime's bench research and could now go forth boldly, without fearing his academic career would be wrecked. Tim Flannery, his Australian equivalent, is similarly placed.
Both have been attacked for their big picture offerings. My own are smaller and more humble, provided as introductions to more hefty works by big ideas guys.
Shooting messengers is easy. What is far more difficult is coming to terms with the reality that science and the future are suffering a criminal neglect. While some of us try to maintain an output to match the urgency it's easy to miss what's happening. Flannery, Swan, Dr Karl, and Winston represent a fading generation. The real future should belong to fresh voices. Where are they?

Jessi Taube, 20, is in her first term of an MBChB at the University of Edinburgh. She went to City of London Girls’ School where she got three A-levels in Chemistry (A), Biology (A), and History (A). She took a gap year in India where she worked in a hospital in Tamil Nadu.

I chose Edinburgh because I liked the city and I thought it looked like a really good course. Now that I am here I actually love the course even more than I thought I would. It is a good mixture of lectures and problem-based learning. We review a medical case each week, we do biomedical practicals and the aim of the course is to show us the personal side of medicine as well as the scientific side.

Typical week

In a typical week we do a lot of work. We start every day at 9am and usually have two or three lectures in a morning, sometimes four. The lectures are an hour long and we are expected to take notes and read around the subject – for example today we had a lecture on female gamete production and infection. We had to consider the basics of epidemiology - how infection spreads and the problems associated with infection control. It was a pretty intense morning with two lectures and then a break, then another lecture and then a break for lunch. I take notes throughout the lectures

Practical-based learning

In the afternoon we either have a free or a practical-based learning session. For the PBL session we are given a theoretical case at the start of the week – for example this Monday we were given the case of a teenage girl who goes to see her GP after having unprotected sex and finds out that she has chlamydia and doesn’t want to tell her partner. We have to tackle each issue from a scientific basis, a clinical basis, an ethical basis and a psycho-social and public health basis. In the first lesson the whole group has a brainstorming session and then we spend four to five hours during the week researching the questions and then at the end of the week we come back together and discuss what we’ve found as a group.

Anatomy lessons

As well as lectures we have tutorials, we do experiments and we have anatomy lessons. We don’t actually do any dissection of the human body ourselves but we have bodies that have already been dissected to examine. The bodies have been donated to the university for us to study and they are already cut up and preserved in formaldehyde. I didn’t think I would be shocked by seeing a dead body, and at first I was OK, but then when I held the heart in my hand I had to step back and take a few deep breaths. When you are working on the cadaver you have to abstract yourself from it, and it is quite weird at first.
We are looking at the physical structures of the body at the moment and we have body parts to examine in different stages of dissection. We cannot do any of the dissecting because there are not enough bodies donated for us all to work on them. In the tutorial there are about 20-30 students and we have four whole cadavers and parts of the body placed around the room. It sounds really ghoulish but you do get used to it.

Respectful behaviour

One of the things that was made really clear to us at the beginning was that we have to be respectful of the bodies. We were given a really strict lecture on how to behave – you cannot be disrespectful and, for example, just pick up a hand and start shaking it, you would be expelled for doing that. It is all part of the ethos of the whole course – to respect the patient and I think we are all pretty aware now of how to behave.

Gap year

The course is exhausting but I really love it. When I was on my gap year in India I worked in a hospital, which was an amazing experience but I missed my school friends and it is so reassuring to come back to university to study. It feels good to know that this is definitely that I want to do.
Living in Scotland and being so far from home was weird at first but my gap year had prepared me for being away.

Social life

I am making so many new friends, it’s really exciting. There are 230 students in my year, and in my tutorial groups there are about 20-30 students. There is a big mix of people from all over the world – for example in one tutor group there are students from Scotland, Germany, Zimbabwe and Northern Ireland. There is a really active social life here. I go out about two to three times a week and at weekends. I live in a catered hall of residence, which provides breakfast and supper so I don’t eat out a lot because I feel that would be a waste of money, but I do to pubs and we go clubbing and dancing.
I found the first week pretty hard – I came up to university not nervous at all and I wasn’t really prepared for the events of the first week – I am in a really big hall of residence and I think I just felt a bit overwhelmed by it all in the beginning, but as soon as I started my course and made friends, it all slipped into place. Best of all, I really love medicine and it has been a lovely turnout meeting some really nice people.