Most people get occasional severe headaches. If they can, they struggle through them. If they can’t cope, they escape to the emergency department or their local doctor to look for relief. The occasional headache sufferer can access top medical treatment at home, if they know how.

Is this a different headache from what you have had before?

If you have a new type of severe headache, that you have not had before, then it is important you see a doctor immediately. There are some danger signs that are particularly important to note, like very sudden (thunderclap) onset, changes in your vision, and muscle weakness or slurring. If you notice any of these things, or unsure about your headache, it is safer to contact you local doctor, or an emergency room doctor immediately.

How do you avoid the doctor when your bad headache gets evil?

Doctors don’t prescribe strong medication for acute headaches, as they don’t work as well as “over the counter” treatments.

The commonest and most effective treatment for headache in emergency departments consists of three points>

1. Take 600mg or 900mg of soluble aspirin

The best sort of aspirin to take is the stuff that dissolves in your mouth. Headache, and migraine can slow down food moving through the stomach, and this can make you feel sick, or even vomit. If you do, you can still take the dissolving aspirin.

This dose is a high dose, and the stronger amount is greater than the recommended dose. It If you consider trying this, start out with the lower dose, which is the recommended aspirin dose for adults. If you would like to try the higher amount, get your doctor’s approval in advance, next time you see them.

2. Give 1000ml of saline (”body water”) intravenously

The major cause of headache in teenagers is dehydration, and it will generally make most headaches worse. Most people can’t give themselves IV fluids at home. However, if you are not going to vomit, then you can take small sips of fluid regularly, over a few hours. If you can take a glass or more of water over a few hours, that will make a surprising difference to how you feel. The best fluid to use is water, or very dilute cordial or juice.

Try filling a water bottle up and keeping it close at hand. And maybe a bucket as well, just in case.

3. Sleep

The first two points are really just about allowing you to go to sleep. A lot of people only give themselves permission to crash out when they collapse. Going to the hospital validates how bad your headache is, and “gives you the right” to go home and sleep. Take control. I am a doctor and I am advising you to sleep when you have a headache. Doctors orders.

I know that this is harder to do than it sounds. Our current culture is consumed by the idea of “soldiering on.” You will need to explain to your family that you are “sick” and need to get sleep. Headache is an illness, and sleep is the most effective treatment. And most of us sleep better at home, so it is worth trying to achieve that.

So it’s so simple: a big whack of aspirin, as much water as you can manage by yourself and sleep. If you can achieve that, you have a greater than even chance of getting headache-free. And it will even work on the evil ones.

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Sites providing a good introduction to Mesothelioma

• Better Health Channel: Mesothelioma

  Better health is a consumer information site in Australia, moderated by the Victorian Government (an Australian State Government). This website is a really nice, simple summary of the causes, diagnosis and treatment of mesothelioma.

• National Cancer Institute: Mesothelioma: Questions and Answers

  The National Cancer Institute is a public cancer research body funded and set up by the US government.

• MayoClinic: Mesothelioma

  The May Clinic is a not-for-profit cancer hospital that is highly regarded in the medical community

• MD Anderson Clinic: Mesolthelioma

  The MD Anderson clinic is another highly regarded cancer clinic in the US. This site is particularly easy to read with nice summaries, and images to clarify explanations.

• The Cancer Council Victoria: Asbestos and Lung Disease

  The Cancer Council is a leading government funded cancer research institute in Australia. This site explains some of the more common asbestos-related lung diseases.

Patient Support Organisations for Mesothelioma

• Asbestos Diseases Association of Victoria

  A real world support group located in Victoria, Australia.

• Asbestos Diseases Forum

  An online forum for discussion with other patients
  

Blogs

Well, there are lots of blogs out there on this topic, but I can’t find anyone who has written about their own experiences with the disease. I think it is likely that patients with the disease have something better to do, but I thought there would be some family members blogging about their experience with the disease. I would even be interested in real blogs from people dealing with the litigation side of it. But they all seem to be set up so people can make money.

Do you know someone writing a good personal blog about dealing with mesothelioma? Please leave a link in the comments section below. Beware - I will delete comment spam on this one!

Mesothelioma Lawyers

I have issues with lawyers who advertise, probably because we don’t do that in Australia. Most websites for personal injury lawyers in this field reek of trying to make more money. If you or your family need legal advice on this subject, then I would encourage you to go to a local lawyer you trust and ask them to refer you to someone who can give you good representation

You can imagine the situation. It’s 7pm and you are just making dinner when you slice your hand with a knife. “Ow! Swear word! Ow!” you exclaim, as you compress the cut with a clean cotton dishtowel (rendered relatively sterile by the iron). The cut is not huge, and you are pretty sure it is not too deep, but it won’t stop bleeding and you think you might need stitches. You are faced with the major modern medical dilemma - how do you find a doctor in the evening outside your local emergency department?

This situation can be stressful and it is often combined with other considerations. Maybe you have to look after your kids. Maybe you have an early start in the morning and can’t be up after midnight just to get your hand chacked. There are a number of ways to make it easier, and less stressful.

Get to know a doctor personally

This is one of the best ways to get to see a doctor when you need them - rely on familial obligation. Be careful with this tactic, though, as it can backfire. If the doctor is a member of your family, you will have to respect them a little bit, as you would if they were a “real” doc. If they are a friend, you really only can do this once or twice before they stop answering your calls. So pick your health emergency with care.

Finally, make sure the doctor you choose to befriend is appropriately qualified. When I was deciding what specialty to choose, my Dad strongly argued against paediatrics, purely because he could see that he would never get his “money’s worth.” For the record, he favoured general practice, surgery or psychiatry.

Get to know Doctor’s staff personally

Most doctors are pretty malleable and are particularly at the mercy of their staff. As in all industries, good staff are hard to find, and you want to do favours for them, if you can. If you can marry a medical receptionist, or carpool with a practice nurse, you will have a reasonable chance to manipulate an after hours appointment in an emergency.

For this to work, you really need to have a real emergency or extenuating circumstances to persuade your friend to pull in a favour from their boss. They must also be a treasured member of staff, so make sure your friend is not a nuff-nuff. The doctor will only go out of their way to coddle a member of staff they want to keep on their payroll.

Call your regular doctor

All primary care doctors have an ethical obligation to provide after hours care. Sometimes they have a roster of doctors on call, or they may employ a locum service. Some prefer you to attend the local after hours clinic. The best way to find out what your doctor would want you to do is to phone their main number and listen to the recorded message.

If you are lucky, you will find out that your doctor has extended their hours since you last checked, or may be willing to stay a little bit longer to fit you in.

Visit a 24 hour clinic or “Super Clinic”

Super Clinics are usually open all hours, often with more staff available after hours. The quality of staff varies, although all are qualified to a minimum standard. These clinics are a good solution for any after hours primary care emergencies, like cuts and grazes, sprains, colds and flus, and childhood illnesses. The system varies, but usually you attend and simply wait until it is your turn. Usually the wait will be longer than an appointment with your regular doctor, but shorter than attending a hospital ED.

These are not good places to go if you have a condition that could deteriorate rapidly, like chest pain, or asthma. It is better to have these things assessed by hospital staff.

These are also not good clinics to attend for regular appointments, as you can’t usually get repeat appointments with the same doctor.

Call a locum service

Locum services provide primary care doctors that make house calls after hours. This is usually a paid service (as are most after hours services). Again, you will have to wait an unpredictable amount of time, as it depends on what other patients have called in. However, you get to wait in your own home for the doctor to visit you. This is particularly valuable if you feel rotten, or you are minding children who are asleep.

Locum services will communicate with your regular doctor so they know what has occurred. If you are not sure how ill you are, locums are generally a good option. You can cancel the call if you decide you feel better. And if your condition deteriorates, you can call an ambulance.

What to do now

When it is 2am and your partner is having an episode of abdominal pain, it is really hard to figure out what to do, and often they are not helpful (she speaks from experience). It is important to figure out your plan in advance. Search your telephone guide right now and find where your local after hours clinics, and the number of your town locum service. Next time you visit your doctor, ask the staff what to do for after hours care.

Being prepared, and in the know, will help you find the “doctor of the night”.

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Recently, my ten month old son pulled a bowl of boiling porridge onto himself. Our lovely family breakfast was shattered by his screams, which cut straight to our hearts. Almost immediately, his sister became distressed, more able to express herself than we were. After a morning in the emergency room, and ten days in silver dressings, the burns to his arm have healed well. At that time, it was a disaster, but we were lucky: we knew that he was sick as soon as it happened. We knew to strip his shirt off and pour water on him. And we knew to seek medical care immediately.

When I was working in the emergency department, we had a patient arrive in the middle of the night by ambulance. He was a two year old boy, and he had a cold. He was unhappy, but not particularly sick. His mother had been investigated by child services in the past and was keen to “prove” that she cared enough. He wasn’t that unwell, but we all understood how she got herself in that situation. I think the junior docs were a lot more understanding than the paramedics, though.

So how do you know when your child is really sick?

Kids can get better very fast, but they can also get very sick very quickly. Unlike adults, they can sometimes seem a lot more settled when they are really sick. This can sometimes trick people into missing the signs, so how do you really know?

Beware of the cuddly child

Children who have accidents or get colds and flus are normally cranky and irritable. They normally have insufficient sleep, and it shows. They often want lots of cuddles, but they are usually pretty unsettled at the same time.

However, when kids get really sick, they can become very flat. “Flat” is a word medical staff use that looks exactly what it sounds like: an infant or child with little facial expression, cuddling their parent, but not really distressed when they are put down. They tend to have no energy, and don’t really react to what is going on around them. Sometimes, it can seem like a sick child has “settled.” But if your child gets sleepy and drowsy, and stops really noticing what goes on around them - call an ambulance. They might be really sick.

Check their nappy or potty

Do you notice when your child goes to the potty? When children are sick they dehydrate rapidly. A lack of wet nappies or wees in the potty is one of the early signs that they are not doing well. If you pick it up early, you can prevent disaster. A common example of this is gastro. Gastro isn’t usually life-threatening and usually only needs hospitalization if the child gets dehydrated. If you think your child might be dehydrated, give them water or diluted juice, or anything they like and can keep down. If you can’t fix it, see a doctor immediately.

Believe your child

My two year old is currently learning how to manipulate her parents. She often tells us she “has a sore tummy,” but if we ask further questions, she explains that she “needs choc to fix it.” Last Thursday, she spent the day telling me she had a sore tummy and needed cuddles to fix it, so I gave her lots of cuddles and reassurance. When I got to the end of the day, I realised she had emptied her bowels four times over the course of the day. In retrospect, she probably was having cramps and was feeling pretty rotten.

Sometimes it is easy to take our kids verbal skills for granted. Often they can tell us when things are wrong and they feel awful: they are not always trying it on. While we deal with their manipulations, it is important to realize they might be telling the truth.

Believe yourself

The truth is, almost all parents know when their child is really sick. Unfortunately, we feel so much pressure to do the right thing and be good parents that we fail to believe our own judgement. It is ok to get it wrong. It is ok to feel stupid. If you think your child is sick, then call an ambulance, beat down doors and wring necks until you can get someone to pay attention to you. You might be wrong, but there is an excellent chance you are right, and that is the only important thing.

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A good primary care doctor, or general practitioner is the key to “playing” the health care system. They can be your passport to skipping queues, finding the best specialist, getting timely appointments, getting the best after hours care, and attention to the things you worry about.

I have written more about the need for a good GP previously. Now I would like to give explain one way to find the right doctor.

How to find your new family doctor

It is totally in our control to find a better doctor. There are very few people that are limited to only one family doctor in their town. Most of us have the luxury of 3 or 5 or 15. However, we get stuck going to a doctor we aren’t happy with, which is silly – patients are the consumers. You wouldn’t go to a bad restaurant every week, so don’t continue going to a bad or even average doctor.

Recognizing that you are the consumer is vital – you are not limited to one provider, and you have no obligation to continue to use a service that you are not happy with.

I always knew these principles in theory, but it took having a family to realise their importance. I had been seeing a doctor for many years, one that I was “putting up with”. I had not been happy with the referrals she made and was not thrilled with her manner, but it was good enough. But when my daughter was born, I realised I needed someone better. My daughter was too precious to entrust to half-rate, “good enough” medical care. So I started looking around all the doctors in my area, and after a few visits, found someone I was really happy with, who continues to care for my family today.

I feel really happy with that decision – it is one of the most important things I ever did to care for my family.

Here is one process for finding a good doctor:

1. Look at your relationship with your current doctor

Are you happy? Do you feel you can trust them, and talk to them about embarrassing problems. Can you get an appointment when you need one? Do you have good conversations. Do you like them as a person, and respect their knowledge? Do they know you and your family and what is important to you? Would you trust them to make decisions about what medication to give you, or what treatment to offer, if they couldn’t discuss it with you?

If you answer YES to all of these questions, congratulations, you have the doctor that is right for you. If you answered NO to some questions, then it may be fixable. Trusting your doctor to make your decisions is the basic test of whether they are right for you. Normally good doctors consult with their patients, but as they can’t possibly explain all the variables, then they will have to abbreviate and select and recommend based on what they know of you. Maybe you need to have a conversation about your priorities, so that thy understand you better.

2. Figure out what you need from your doctor.

Is the gender of your doctor important to you? Do you have to be able to get an appointment at the last minute, or is after hours service more important? Is it more important to have a free service, or are you willing to pay out of pocket to go to the right doctor? Should the practice be close to home or work? Do you need a doctor who is right for all your family, or are you willing to go somewhere else to find someone that suits you personally?

3. Try someone new.

It doesn’t really matter who you try, but feel free to try as many doctors as you like. You have an opportunity every time you get sick. You can try recommendations from friends or family, or you can just work you way around the different practices. It is ok to try someone out. You are not obligated to continue seeing the same person. Remember, you are the consumer, and they are providing the service. You will probably have to fill in new forms at every place you go to, but that doesn’t oblige you to keep going.

4. When you find someone you like, tell them all your secrets

The best way to form a relationship with someone is to share your trust. Doctors need to know all the background to your health to help you make decisions in the future. Let them know about all the little things about your health, and your relationship will develop so that you can trust them when you need to.

5. If you get disatisfied again, repeat this process

Most importantly, never give up. Your needs change over time, as mine did when I had kids. If you retire, you will probably be less demanding about after hours appointments. If you develop a chronic illness, you may prefer a different style of practitioner.

In today’s “ehealth” environment, we are not stuck with the same doctor for life, so claim your right to upgrade. Find the right doctor, and start to take more control of your healthcare.

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Myths and Legends:

If you travel by ambulance, you will be seen by a doctor more quickly.

No. Unfortunately, this is urban myth, and can even slow things down (if you get a triage nurse in a bad mood). This myth probably comes about because most really sick people get taken to hospital by ambulance and really sick people get seen pretty fast in emergency. Also, the paramedics are experts at communicating how sick their patients are, so sick patients usually don’t get delayed, as can sometimes happen with less experienced patients. But this skill can be learnt.

If your local doctor is closed, there are no other options but to go to the Emergency Department.

If you have the sort of condition that is well-treated by a local doctor, there are much better ways of being seen in an emergency than by visiting the emergency department. Both “24 hour clinics” and locum services offer GPs after hours. The doctors can be extremely experienced practitioners and the wait can be a lot less than going to the emergency department. With locum doctors, you even have the advantage of getting to wait in your own home, which is fantastic if you have kids asleep in another room. Although you have to pay for these services, they will normally offer better care, faster than you will get by going to the ED.

It is a waste of time to go to a private Emergency Department!

Not true either. It can be expensive to visit an emergency department in a private hospital, but you get rapid treatment by experienced professionals. If you have an injured child who just wants to go to sleep, then a private hospital emergency may be the fastest way to get them checked out and fixed in time to go home. If you are going to be admitted, and are willing to be treated as a private patient, this may be one of the fastest ways to get into hospital. Be aware that not all private hospitals have an emergency department and not all will treat public patients who agree to pay up front.

If a kid is sick, then they need to go the the Childrens’ Hospital.

The Children’s Hospital is specialized for the care of sick children. They can deal with any condition that presents itself. However, almost all other hospitals look after sick children, too. But they can deal with only run-of the-mill problems like asthma, croup, accidents, cuts, broken bones, gastro, simple infections…. the sort of things that are the most common. So, if you have a sick child, who is normally well, and you think they need to go to hospital, your local hospital is normally well-equipped to look after them. There is another advantage of visiting an “adult” hospital - most nurses can’t bear to see a sick or sad child wait, so they will send you into a room as soon as they possibly can, prioritizing you over an adult patient if possible. Triage Nurses at children’s hospital usually don’t have this luxury, as none of their patients are adult.

You always have to wait in the emergency department.

Emergency Departments are busy at predictable times, as emergencies tend to happen at about the same time. You can’t make yourself sick on a schedule, but you can change your behaviour to access the ED at quiet times. Quiet times tend to be first thing in the morning (especially on weekdays) and in the early hours (from about 3am until 6am). EDs are usually very busy in the evenings from close of business until midnight (later on weekends), and weekend afternoons. They also don’t see many patients at shift-change between 6:30 and 9am in the morning. So if you feel unwell in the middle of the night, it is not alway worth waiting until morning. If you get sick in the evening, it is worth looking for another solution.

There is nothing you can do to be seen quickly.

If you are at the emergency department because you or your family member is very sick, you can make sure you let the triage staff on the front desk see the situation clearly. These staff are nurses and are keen to figure otu quickly who is most sick, but we sometimes make it harder. Carry your screaming baby to the desk with you. Interrupt the nurse to say your father has been burnt. Take your sick mother up to the desk, so that the staff can see how sick she is (this is much more effective than simply telling them). This is the way that ambulance staff get their patients seen quickly if they are sick.

We patients sometimes get caught up in “being polite” and avoiding “annoying other patients,” and make it more difficult for the staff to know what is going on. Eventually all patients will be seen by the nurse and examined, but if you or your family-member have severe pain, or can’t breathe, or are very distressed, you sometimes don’t have to wait to be assessed. It is up to you to make sure the nurse knows what is happening.

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How should I take stock?

This is the easiest thing in the world, but it will involve a little time. Take a paper and pencil, your favourite word-processor or one of the more technological solutions suggested below, and make three lists.

1. List all your present and past medical conditions

This includes anything you were treated for as a kid (you can leave out colds and flu’s unless they caused a hospital admission), anything you have been in hospital for, or taken long term medication for. Take a highlighter and mark those conditions that you think are still important to your health. For example, if you had a hip replacement 6 years ago, it may not cause you problems now, but you know that it might break down at some point in the future, so you still need to be aware of it.

2. List all the medications you now take

Try to work out for each medication when you are meant to take it, how many you should take and how strong the tablets/injections are. If you can, write out what the medication is for, and what other names it has. Finally, try to make a guess of how regularly you actually take the medication correctly. Remember, you are the only one that is reading this.

3. List all the doctors and health professionals who look after you

Make sure you have their contact details and write down which conditions each of them thinks they help you look after. Write down the next appointments you have with any of them. For each write down when you should make a new appointment. For example; “Make an earlier appointment with Charlie the Physio if I have worse back pain.”

Let these lists bounce around in your head for a little while to make sure they are complete and you haven’t forgotten anything. Now take a good look at your lists.

There are probably some conditions that you are not sure about, and don’t understand. Maybe there are medications you don’t know what they are for, or are forgetting to take. For those medications that you are worst at taking, make sure you know what they are meant to be treating. Check your final list to make sure all the doctors and clinics you see are listed, and you are not due for a new appointment with any of them.

What is Google Health?

Google Health is a new service offered by the omnipotent Google. Basically the idea is you enter all of your health information into one secure account. It keeps a track of all your conditions and medications, and all of the information that was previously on index cards (or in your head) is kept secure.

But there’s more. With your account, you can access interesting information about your conditions, search for US doctors and navigate to their websites, keep track of doctor contact information and even share the information you have entered with other people. This works in a secure way, and could be used to give your health information to a doctor, or your next of kin in case of an emergency.

This is not the only product in this market. HealthVault and Revolution Health offer similar products.

How does reviewing your health information help? What should I do now?

Once you have your health information in one place, save it and review it regularly. It is to your advantage to know what is going on with your health. If you have a printable or paper version, tuck it in the corner of your purse and keep it with you. This improves the care that you get - both in preventative medicine and any emergencies that occur.

I have seen this system in use and it works wonderfully. It wasn’t initiated by me, but my obstetrician when I was pregnant with my children. At the end of each office consultation, she would print out a summary of all the tests results, philosophical discussions and medications that were relevant. When I arrived for my deliveries in a state of panic and disarray, I handed the most recent print out to her, and she knew everything she needed to. It would have been the same if we ended up in a strange hospital or if her computer battery failed. It was the perfect solution to reduce my stress, and make her job easier.

Try your health audit today. Make sure there are no chinks in your knowledge and you will reap the health rewards.

Being a patient is sometimes difficult, humbling and embarrassing. However, dealing with doctors can be easier, if you are a smart consumer. You can improve your healthcare, and get more out of your experience, by using smart strategies.

There is a lot of information available on the internet on “How to Be a Good Patient”. The articles seem eerily similar - health-care providers giving patient’s tips on how to behave in an appropriate manner. This advice seems, to me, more about the provider than the patient, “Behave like this and I will find you easier to deal with and therefore have more energy to sort out your problem.”

Healthcare doesn’t have to be oppositional. In fact, a doctor and patient should be acting as partners to reach a common goal. There are simple things that you can do to make sure you know what is going on and therefore be more in control. If you feel in control, you will be able to communicate more effectively with your doctor.

How Patient Hacker can help you

Patient Hacker is about making sure consumers understand what they need to do to achieve good healthcare. We will touch on strategies to help you:

• Find doctors that you trust and who understand you
• Find up to date information about your medical conditions, without trawling through potentially dodgy sites
• Get clear information from your doctor about what they are thinking and planning

and

• Understand the risks of health treatments, and why they are (often) worth taking

Please read through the blog and use the comments to participate in discussion. We would love to hear any strategies that have helped you develop a better partnership with your health carers.