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Don't Ask, Do Tell

Ten questions your doctor isn't asking you-and why the answers can help you get healthier.

Sure, it's easy to feel exposed in a physician's office-you have to get on a scale, your chart is open and you're sitting there in a paper gown-but, in reality, there are many things that your doctor doesn't know about you, and without this vital information you may not be getting the right treatment.

When you go to see your doctors, you get about 10 minutes of their time. Most often, women go to a doctor for something urgent, such as a cold or flu, or to check on a recurring problem, such as diabetes, high cholesterol or high blood pressure. With so little time slotted per patient, most doctors jump right in and focus on these urgent concerns. There may not be time for your M.D. to ask you some very important questions.

Don't wait for your doctor to take the lead. Before your next doctor's appointment, ask yourself the following 10 questions. The answers may well bring up topics you need to discuss with your doctor.

What over-the-counter supplements are you taking?

Even if the bottle proclaims, "all natural," it's crucial that your doctor knows which vitamins and supplements you take. Some supplements can affect your prescription medications, or cause side effects that might be mistaken for other medical problems.

Recent studies have questioned the benefit of mega doses of vitamins such as C and E, and even seeming innocents like calcium can be taken in doses that might promote medical problems, such as kidney stones.

When it comes to supplements, remember three things:

1) Youth cannot be purchased in a small, brown bottle.
2) Many supplements can interfere with your prescription medications.
3) No matter how hard that vitamin or supplement is to pronounce, it's worth mentioning at your next visit. Or just bring in the bottle.

Are you happy at home?

This one simple question can open up a Pandora's box, as this area of life can be the source of so much stress that it can affect you physically. Is a marriage unraveling? Are you having trouble with the teenagers? Is there violence in the home?

The stress of relationships can affect the quality of sleep you get, and take time and energy away from eating properly and getting enough exercise. Most women have multiple roles in the family, caring for children, grandchildren and parents-sometimes all at the same time. Perhaps this burden has manifested in overall fatigue, headaches or high blood pressure.

Since your home life affects you not just mentally, but physically, your doctor needs to know what might be contributing to a specific complaint. Joint pains, for example, may be caused by a lack of sleep. In this case, short-term use of sleeping aids, exercise and a focus on relaxation techniques could be much more effective than taking other medications.

If there are any problems with violence in the home, you need to tell someone immediately. Whether you are being abused by a spouse, significant other or even your own child, your doctor can refer you to social workers, who will assist you in finding a safe place. There are many resources readily available for those in need, and your doctor should be viewed as one of them.

A stressful home life can also lead to depression, a particular problem for women. According to the National Institute of Mental Health, major and minor depression occur in women twice as often as in men. Yet depression is a highly treatable disease and can be combated with individual therapy, exercise regimens, medications and more. If you feel that your mood may be affecting your health, mention this to your doctor.

Can you afford this?

We all know that office visits are expensive, yet prescription drugs are the most costly part of most patients' medical bills. According to a national survey published in the May/June issue of Health Affairs, almost one-third of all prescriptions written are not used as directed, or taken at the full dose. As medications have gotten more expensive, patients turn to pill rationing, and the elderly are especially hard hit. A doctor could inappropriately increase a medication's dosage, thinking that the drug is not taking effect, when, in fact, it's not being taken at all.

Your doctor can work with you to help reduce costs, with methods such as samples of medications, drug discount cards, generic medications and insurance coverage for drugs.

Is your job making you sick?

Your job gives you a paycheck and, hopefully, a sense of satisfaction, but the workplace can also seriously affect your health.

One reason is the sheer amount of time we spend working. According to the Center for Religion, Ethics and Social Policy at Cornell University, Americans put in longer hours on the job now than we did in the 1950s, and are, in fact, working more hours than the citizens of any other industrial country. The center reports that we work nearly nine full weeks longer than our peers in Western Europe, and average two weeks of vacation while Europeans average five to six. With this much time spent in the workplace, conflicts and stress are hard to avoid.

Even the physical workspace can take its toll: mold, for example, is a common problem in Hawai'i. Cramped desks or poor seating can lead to carpal tunnel syndrome, from which women suffer three times more often than men.

If you have a nagging health problem, note when and where you feel the worst-is it at work?-so that you can help your doctor identify the cause.

How do you feel about your weight?

Many women want to lose weight, and their doctors might agree with them-obesity has become a nationwide health crisis. According to the Centers for Disease Control, almost one-fourth of all Americans are considered obese. Your doctor can help you figure out which weight-loss and exercise programs will be the safest for you to start.

Even if you appear to be at a healthy weight, doctors often miss the opportunity to ask about eating behaviors. Bulimia, anorexia, compulsive overeating, yo-yo dieting-each is a serious challenge to your health, and may require specialized testing. Past eating disorders should also be considered, as they can set you up for medical problems, including osteoporosis.

If you can't talk about your weight or issues with food for yourself, do it for your daughters or nieces: A recent study at UCLA showed that women who have a female family member with anorexia or bulimia are ten times more likely to suffer from the disease themselves.

How is your sex life?

No one wants to discuss it and no one wants to ask, but, lurking in the silence, there can be significant problems in the bedroom. Perhaps a partner has started using Viagra and that has raised issues in the relationship. Maybe the birth of a child has affected a couple's sex life. Have your birth control concerns been properly addressed? Are you feeling a loss of libido, which can signal a lack of estrogen or testosterone in women, and can be treated?

Vaginal dryness, painful intercourse and other sexual health issues are common in women and can often be easily corrected, so jot down some notes on what you'd like to discuss with your M.D.

Do you use drugs?

There are many preconceived notions of who is using drugs in the United States. The most commonly abused drugs are alcohol, tobacco, cocaine and marijuana.

Doctors can forget to ask about drug use, or don't think they have to, based on a person's age, gender or appearance. And the follow-up question, "How much?," is often overlooked, too. "I drink wine each night," or, "I only smoke when I'm out," means something different to every person.

Women are at particular risk when it comes to alcohol abuse. According to the National Institute on Alcohol Abuse and Alcoholism, women are more likely than men to develop alcoholic hepatitis (liver inflammation) and to die from cirrhosis, and female alcoholics have death rates 50 perecent to 100 percent higher than those of male alcoholics. Women are at risk for other potential effects of heavy drinking, including breast cancer and fetal alcohol syndrome.

Female smokers also face different issues than male smokers. Female-specific risks include cervical cancer, premature menopause, infertility, osteoporosis and serious complications related to the use of oral contraceptives, including strokes and blood clots.

The bottom line: Whether it's legal or not, all drug use is pertinent to your health.

Are you following your doctor's advice?

Many times, doctors make recommendations for diet, exercise or medication-and wrongly assume that patients are following every bit of advice. It's often not true. For example, in a recent survey by the National Institutes of Health, less than 5 percent of Americans comply with the recommended hour of exercise and healthy diet recommended by the Food and Drug Administration.

If you can't follow your doctor's directions-say so. Your doctor can help figure out the obstacles, address concerns and, where possible, suggest reasonable alternatives.

What hobbies do you enjoy?

Certain leisure activities lead to specific health concerns. For example, being an avid swimmer puts you at a greater risk of developing an ear infection, while runners are more likely to develop leg pain. Gardeners might need to keep up to date with tetanus immunizations if they are in contact with rusty metal objects on a regular basis.

Regardless of your hobby, if you spend a lot of time outdoors or have exposure to chemicals of any kind, it's important to mention this part of your life to your doctor.

Do you sleep well?

Sure, most of us would love to skip doing the laundry and get more sleep, but there can also be medical problems depriving you of a full night's rest. Getting eight hours of sleep is optimal, but for many, sleep is often interrupted by the urge to go to the bathroom, which can be a sign of bladder problems.

Sleep can also be disturbed by excessive snoring (by you or your partner), which can indicate a condition called sleep apnea. Sleep is the time when the body heals itself and replenishes energy stores, so not getting enough rest can affect blood pressure, heart function and your immune system. OK, so now you've asked yourself the tough questions. Use your answers to help your doctor keep you as healthy as possible. At your next visit, ask to update your medical history with some of this information. Your doctor-and your body-will thank you.

Kathleen Kozak, M.D., MBA, is an internist at Straub Clinic and Hospital in downtown Honolulu.

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,October

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