8 Tips for Staying Healthy and Happy During the Holidays

Christmas, Hanukah, New Year’s—these are supposed to be times of celebration, togetherness, and happiness. Yet, they can bring challenges to our physical and emotional health. Here are 8 tips for staying healthy and happy during this holiday season.

1. Eat well. It’s common to pack on 5-10 pounds during the holiday season, but there are ways you can eat both healthy and well! Know which foods are high in caloric content and low in nutrition. Don’t deprive yourself of such treats, but indulge in moderation. Eat smaller meals instead of “saving yourself” for one huge buffet. Opt for healthy options at home, and when visiting others, bring a healthy dish to share. Be careful of liquid calories, including alcoholic beverages.

2. Stay active. Exercise is just as important during the holidays as any other time of the year. You should be active at least four to five times a week, preferably with some aerobic exercise every day. The weather may be cold outside, but the winter offers additional fun, too! Ice-skating, sledding, snow sprints—all of these can be great exercise. Enlist your loved ones to join you for quality bonding time.

3. Prevent illness and injuries. Colds and the flu are most prevalent in the winter. Prevent them by washing your hands regularly and urging others to do the same. Stay warm by dressing in layers. Sprinkle sand on icy patches. Watch young ones, and assist the elderly, who are at increased risk of falls and other injuries during this time.

4. Check your heating system. Making sure your heating works and is safe. Carbon monoxide emergencies can be fatal. Install a carbon monoxide detector and test it once a month. Keep grills and generators out of the house, and don’t run your car for long periods of time in the garage. Most residential fires also occur in the winter; never leave fireplaces, stoves, and candles unattended.

5. Travel safely. Whether you are going down the block or halfway across the world, follow extra precautions. Give yourself plenty of time in the additional holiday traffic. Never drink and drive. Be on the lookout for reports of extreme weather and heed warnings. If you’re traveling away from home, make sure to pack and take your medications. Know how to contact your doctor when you are away and have a medical problem, and where the local ER is.

6. De-stress. Holidays can be a stress time. You may be working, and feel the stress of managing your work duties along with additional commitments to your friends and family. You may feel the financial stress of gifts, and the interpersonal stress of conflicts. Try to anticipate sources of stress and develop a plan to manage them. This may involve committing to fewer get-togethers or setting a tighter budget. Don’t feel guilty; you have to take care of yourself before you can take of others.

7. Help others. Depression and suicidality increase during the holidays. Watch for signs of depression among your friends and family. Take an active role to support those in need. Invite those colleagues or friends who are alone over the holidays to spend them with you. Volunteer and give to those less fortunate.

8. Treat yourself. The holiday spirit is about helping others around you, but you also have to make time to take care of yourself. So treat yourself with something over the holidays. It may be something as simple as sleep. Sleep in and enjoy a day of rest; you need it. How about reading that book you’ve been meaning to for a long time, or getting a manicure or massage? Take the time to do the things that make you happy.

I hope these tips have been helpful! Do you have other tips to share? I welcome your comments. And happy holidays!

You Can Catch a Cold From Being Cold and More--8 Common Health Myths, Debunked

This weekend, I am presenting a session at the Asian American Women Leadership Conference to high school and college students about taking care of our bodies. One the topics is common health myths. Despite our best efforts at debunking them, here are 8 pervasive myths:

#1. You can catch a cold from being too cold. Growing up, how many of us have heard this from well-meaning parents and grandparents? It’s easy to see how this myth came to be. People do get more colds in the winter. Going outside in the cold without proper protection isn’t particularly pleasant, and if you do it enough, might lead to a weaker immune system. However, we also know that colds are viral infections that are transmitted through viruses. You catch a cold from someone else who has a cold, not from being too cold yourself. So, to avoid catching colds, be diligent about washing your hands (though bundling up in cold weather isn’t a bad idea either).

#2. You will get blind if you read in low light. If this is the case, then our ancestors will surely all have suffered from blindness! It’s not true that reading in low light leads to blindness. That said, why strain your eyes unnecessarily? If you have the choice, read in an environment with lighting that is pleasant to you.

#3. In order to tan, you must burn first. This is definitely NOT true. Sunburns are potentially dangerous, and can lead to sunstroke and dehydration, not to mention skin cancer. Tanning itself carries similar risks. How much you tan depends on your skin type (there are some people who burn and never tan, for example), but you should definitely not plan to get sunburned in order to tan.

#4. Muscle turns to fat if you don’t use it. Anatomically, this just isn’t the case. Muscle and fat are two different types of tissues, and one doesn’t turn into the other. However, there may be some truth overall in that if you don’t exercise, you lose your muscle mass. If you consume the same number of calories as when you were exercising, you will probably gain weight. So make sure to exercise regularly!

#5. Alcohol kills brain cells. In junior high, I watched my teacher drop a rat brain into alcohol, and the alcohol seemed to eat away at the brain. So alcohol kills brain cells, right? Well, not exactly. The alcohol that you drink enters your bloodstream, and doesn’t actually attack your brain directly. Of course, there are other ways for alcohol to injure your brain: for example, binge drinking can lead to decrease in breathing and injury to your brain that way, and drinking while driving has many other dangerous effects. As with everything else, drink responsibly, and in moderation.

#6. People are fat because they don’t exercise. While exercise is necessary to maintain good health, the primary contributor to being overweight is poor diet. An overweight person will have difficulty losing weight by exercise alone; a good diet with decreased calories is also necessary. Genes also play a role. That doesn't mean you shouldn't exercise if you want to lose weight--but make sure you also change your diet.

#7. Birth control/HPV vaccine/etc leads to more sex. A myth like is testament to people using anything as “research” to support their views. It’s hard to imagine that anyone will choose to have more sex because they have better information and a few shots in their arm. A better way to think about this is that people are going to be sexually active anyway. Why not empower them with information to make good choices (i.e. birth control and sex education)? The HPV vaccine can guard against cervical cancer; why not protect our young?

#8. Women need annual pap smears starting from age 18. This used to be the case, but the guidelines have been revised such that it’s recommended for women to get pap smears every three years, starting from three years after they begin sexual intercourse. This doesn’t mean that you should only see your doctor every three years; an annual woman’s visit is beneficial for a number of reasons, including checking up on your health in general and addressing other aspects of your sexual health.

Many of these myths are partially based on the truth; that’s why it’s so hard to sort them out. Yet, they have been proven time and time again, with a variety of scientific studies, to not be true.

Do you agree? Disagree? Have other myths that you want to share? Please write your comments below! I would love to hear from you.

From Doctor-Centered to Patient-Centered Care

Growing up, I always thought of hospitals as having a certain mystique that was impenetrable to the outside world. White-coated figures paraded through long hallways that had a permanent antiseptic smell. People spoke in hushed tones except for the loudspeaker that blasted information about “codes”: real emergencies! There were many doorways marked “do not enter” and “restricted access”, where I imagined miracles to happen: real-life operations, cures, magic! As a child with severe asthma, I visited this world often, and dreamed about the day I would penetrate this mystique and be among the white-coated magicians on the other side.

As a medical student, I continued to hold the medical world in great awe. All that changed the day my mother became a patient. I began to see firsthand not only how difficult it is to navigate the healthcare system, but also how scary and unwelcoming the hospital can be. After my mother’s extensive cancer surgery, she was supposed to be recovering, but every few hours, someone would come in and turn on all the lights. There were loud beeping noises all the time; soon, she lost track of day and night. Her providers came to check on her at their convenience, but when she asked for help, they rolled their eyes, dragged their feet, and sighed.

For fear that she would be perceived as a “trouble patient”, she—and I—began to hold everything in. This extended to her oncologist, where she often didn’t mention that she had concerns with his recommendations, and certainly to her visits to the hospital. There was a particularly unpleasant ER experience where she, then a chemo patient, lay freezing in the hallway for five hours. After she got yelled by a nurse for walking herself to find a blanket, she decided that she just wasn’t going to the hospital any more. “Every time I go, I feel like I’m begging them, like it’s a huge favor to get care,” she told me. “I can’t do it any more.”

As a medical student, I was torn and conflicted. I was finally entering this world that I had so long revered. But I also saw the serious problems with our healthcare system and how it hindered care for the person I loved most. I’m not even talking the costs of health or healthcare disparities, but even more basic issues. Such as, why is that caring for patients is doctor-centered and not patient-centered? Why is that hospitals are designed for doctors and nurses, but not for the people they are supposed to serve?

Since my mother’s unfortunate experiences, there have been some positive changes. Patient- and family-centered care movements are growing across the country. Hospital systems are recognizing that in order to deliver first-rate care, they must value the patient’s experience. Dr. David Feinberg, CEO of the UCLA health system, talks about how he spent the first several months on the job listening to patients. What he heard was so shocking, so imperative, that he challenged his 18,000-member staff to redesign their entire vision of care delivery. For example, he made sure that patients were part of every committee. “How can we deliver patient-centered care if patients aren’t part of the process?” he says.

Changing long-entrenched systems is by no means an easy task. There are some who believe that the mystique of medicine is important to preserve. In some ways, this might be true—there is something inherently different, inherently special, about medicine and how doctors should view their commitment to patients and society. As a senior resident physician completing my training this year, I believe more than ever that medicine isn’t just a “job”, but rather a special kind of calling. 

Which makes it even more imperative to change the disconnect that hospitals have with patients and their needs. We as healthcare providers need to make it our top priority to make sure that our practices are truly patient-centered so that we can work with our patients to focus on our common goal of healing and improving health and well-being.

How to Begin the Partnership for Shared Diagnosis and Shared Decision-Making

In my last post, you met Catherine, a young woman who came down with a stomach bug but was ushered through numerous blood tests and a CT scan, only to be even more confused than ever. You saw how shared decision-making needs to begin with the process of establishing a partnership for shared diagnosis, because diagnosis is the first and most critical step to your medical care.

Here are 5 steps to partner for your diagnosis:

#1. Find a physician who agrees with shared decision-making for diagnosis. Your doctor should listen to you, care about you, and feel comfortable—even seek out—involving you as a partner in the decision-making process. You will quickly see whether your doctor gives lip service to the partnership or really believes in it. Someone who really believes in it will work with you and welcome and actively solicit your suggestions. Someone who isn’t will quickly exhibit signs of impatience and defensiveness. If you are always respectful while asking questions, your doctor should welcome the input rather than feel challenged by it.

#2. Express your intentions to your doctor. Doctors aren’t mind readers, and are probably conditioned to patients being passive participants in their healthcare. No matter if this is a new doctor, or one that you’ve had a relationship with for a while, state clearly at the beginning of your visit that you want to be involved as a partner in your own decision-making process. Ask to share in your doctor’s thought process about your diagnosis. Inquire about what it is he/thinks you have. Say that you want to be involved in figuring out what you have and what to do. If your doctor does not respond positively, perhaps it is time to look for another care provider.

#3. Help your doctor help you. Most diagnoses can be made by the story—the history of your illness—alone. Yet, one of the most frequent complaints patients have is that their doctors don’t listen to them. No doubt, there are limitations and pressures on the doctor’s time, but neglecting to listen to you will result in misdiagnoses. You can help make sure your doctor listens to you by telling agood story. Rehearse it in advance and make sure you tell a concise version. Begin at the beginning and proceed chronologically. Provide context, such as how it affected your life. Use your own voice instead of what you think is medical jargon. Write down key details so you don’t forget, and practice the delivery. Knowing how to convey your story effectively is a key part to helping your doctor help you get to the right diagnosis.

#4. Make sure you understand every test that is ordered. Every test should be done for a specific reason. Study after study shows that there is no role for the “screening” test: doing “basic labs” or a “screening CT” is like fingerprinting the entire city to search for a suspect, because it’s ineffective and likely to end up with confusing results. Not to mention that every test, even the basic blood draw, has potential harms (a CT has many more potential harms, including increasing your lifetime risk of cancer). If your doctor asks for lab work to be done, ask what blood work is requested and why. If your doctor asks for a CT scan, x-ray, MRI, etc, ask what it is looking for. How is the test going to change your management? Is it necessary? What are the possible harms? What are the alternatives? These are the same questions you would ask if you were deciding whether to treat and how to treat your illness, and making the diagnosis should be no different.

#5. Make decisions together, always with the diagnosis in mind. A test or procedure should be done only if it helps make your diagnosis; otherwise, what’s the purpose? The treatment should be targeted to the diagnosis; otherwise, what is it being done for? Perhaps there are two or three possible diagnoses; what is going to be done to try to narrow this down? What’s the natural course of the illness; what should you expect and what can you do to start feeling better? You need to be proactive in thinking through and asking questions, and if you have a willing physician (as you should), you should have all of your questions answered. Keep asking if your diagnosis does not make sense to you.

A critical component of shared decision-making is to work with your doctor to figure out your diagnosis. Focusing on this first, key part of your care will have transformative effects on your health.

Imagine, how different would it have been if Catherine were involved in the very beginning with her diagnosis. She would have been able to tell her story and ensure her doctors listened, which could have led to the diagnosis without any tests at all. She would have avoided an unnecessary CT scan and unnecessary blood work, along with the all the potential harms and confusion of the tests. She would have received her diagnosis and understood what it is and how to treat it. She would have gone home, reassured and feeling better.

You may be dissatisfied and frustrated by the way your medical care is today, but there is a way to make it better. You hold the key to transforming your health. Try it on your next doctor’s visit, and focus on shared decision-making towards making your diagnosis.

Tried it? Have suggestions? I welcome your comments!

The Forgotten First Step to Shared Decision-Making: Partnering for Your Diagnosis

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Catherine Smith is a 39-year old woman who is confused, scared, and feeling terrible. She is generally pretty healthy and active, but this morning, she woke up feeling queasy. Throughout the day, she began throwing up and having diarrhea. She wasn’t keeping anything down, so her husband convinced her to go to the local ER to get checked out.

In the ER, she had an IV placed and blood drawn. A nurse and then a doctor asked her some questions. She was told she had to drink some thick white liquid. A couple of hours later, she felt better. She could go home, right?

No, she was told; she was getting a CT scan. Nobody told her this earlier, but OK, she reasoned, she has to trust the doctor; isn’t that why she came here?

So she dutifully got into a donut-shaped machine. A couple of hours later, she was told that the test was “negative”: she didn’t have appendicitis or gallstones. Of course not—she had her appendix and gallbladder removed years ago!

“Good news,” the doctors said to her. “We have “ruled out’ the worrisome things. You can go home!”

But Catherine didn’t understand. Why did she get so sick in the first place? What was the point of the tests? She was feeling nauseous again—was this going to keep happening? Is she going to be OK?

**

I’m an emergency physician, and Catherine was my patient. Actually, I see patients like Catherine every day, patients who are confused about what’s going on and dissatisfied with their medical care. We in the U.S. believe that we have the best medical care system in the world, yet our healthcare consumers are more unhappy than ever. Patients don’t feel like their doctors listen to them or take their concerns seriously. They are subject to endless tests, but, at the end of the day, still have no idea what they have or how to get better. They keep being told that they need to be "empowered patients", but are not involved as an equal partner in their care.

The shared decision-making movement is gaining much-needed momentum and traction. I applaud it whole-heartedly. Yet, the movement so far has focused on shared-decision for treatment. Don’t get me wrong; it’s very important for patients to share in the decisions about weighing chemotherapy agents versus surgery for cancer, deciding between lifestyle changes and starting medications for high cholesterol, and so forth. What I argue is that patients have to be involved in an even earlier and more fundamental part of the decision-making process: the diagnosis.

Why is the diagnosis so important? First, it’s important for you to know what you have before you can treat it. You have to know what disease or process you have so you know what to expect, what to watch out for, and what you can do about it. Throwing medications at symptoms just masks them, but doesn’t get at the root of the problem. Second, not knowing what diagnoses are being considered is equivalent to searching for a needle in the haystack: it’s aimless and dangerous. Tests should be done to narrow down diagnoses, or else results are going to be obtained that don’t make sense, and you still won’t know what you have—like Catherine.

Wait a minute, you might be saying. Isn’t it the doctor’s job to figure out the diagnosis? How can patients possibly help in this process, if you are not the ones with the medical training? My patients are surprised when I tell them that, actually, they are key to their diagnosis. At first, they don’t believe me. With time, they understand what I mean that only you can convey to your doctor the symptoms you’re having and the story of your illness. Only you can help your doctors narrow down the possibilities and arrive at the answer. Only you can be sure that your doctor listens to you and focuses on getting you to your diagnosis. Only you can really advocate for your healthcare.

I go as far as to tell my patients to never leave their doctor’s office without getting a diagnosis. It doesn’t have to be the final, 100% definitive diagnosis; after all, it’s very rare to be 100% sure of the exact cause of each and every illness. Catherine probably had a stomach bug—a simple viral illness. Am I 100% sure it can’t be something else, like food poisoning? No, but nor do I have to be 100% sure, because the management and the expected course of her illness will not change. And with every symptom, there are the “scary” things to watch out for, in this case, things like ectopic pregnancy or ovarian problems.

It’s important to consider these scary causes, but “ruling out” problems should not be the only goal. In fact, the goal should be to arrive at a most likely diagnosis. This is what will aid you in guiding your decision-making and your thinking about what tests, if any, are needed. This is what will inform your understanding, your questions, your treatment, and your follow-up.

It is critical that you work with your doctor to make sure you are an equal partner in the process of getting to your diagnosis. My next post will address what, exactly, you should do to engage in this key first step to shared decision-making. In the meantime, I welcome your comments, and also invite you to visit the website for my forthcoming book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.

How a Stubborn "Western" Physician Came to Appreciate Eastern Medicine

As a child growing up in China, I was always aware of Traditional Chinese Medicine (TCM). TCM is what we refer to as Eastern medicine, in contrast to the Western medicine we know from U.S. hospitals. I never understood much about TCM, only that it somehow involves herbs and that many Chinese people believe in it. The more I progressed in my medical training in major U.S. academic centers, the more distanced I felt from TCM. Why should I learn about something that lacks evidence, when there’s so much to know about for which there is good research?

For the last month, I have been in China studying its medical education system. While my study is primarily on its Western medical system, I have been so fascinated by what I learned of Eastern medicine that I spent many free evenings observing TCM practitioners. There is so much I didn’t know. For example, I had no idea that many TCM doctors in China undergo rigorous medical training, and actually take the same courses as Western medicine doctors in addition to courses in herbs, acupuncture, cupping, etc. As a discipline, TCM is far too complex for me to understand in my short observation, but there are some very important “lessons from the East” that are applicable to our Western medical practice:

#1. Listen—really listen. The first TCM practitioner I shadowed explained to me that to practice TCM is to “listen with your whole body”. Pay attention and use every sense you have, he said. I watched this doctor as he diagnosed a woman with new-onset cervical cancer and severe anemia the moment she walked into his exam room, and within two minutes, without blood tests or CTs, sent her to be admitted to a (Western) medical service. I’ve seen great emergency physicians make quick diagnoses and disposition decisions, but this was something else! “How could you know all of this?” I asked. “I smelled the cervical cancer,” he said. “I looked and saw the anemia. I heard her speak and I knew she could not care for herself at home.” (I followed her records in the hospital; he was right on all accounts.)

#2. Focus on the diagnosis. I watched another TCM doctor patiently explain to a young woman with long-standing abdominal pain why painkillers were not the answer. “Why should we treat you for something if we don’t know what it is?” he said. “Let’s find out the diagnosis first.” What an important lesson for us—to always begin the diagnosis.

#3. Treat the whole person. “A big difference between our two practices,” said one TCM doctor, “Is that Western medicine treats people as organs. Eastern medicine treats people as a whole.” Indeed, I watched her inquire about family, diet, and life stressors. She counseled on issues of family planning, food safety, and managing debt. She even helped patients who needed advice on caring for the their elderly parents and choosing schools for their child. This is truly “whole person” care!

#4. Health is not just about disease, but also about wellness. There is a term in Chinese that does not have its exact equivalent in English. The closest translation is probably “tune-up to remain in balance”, but it doesn’t do the term justice, because it refers to maintaining and promoting wellness. Many choose to see a TCM doctor not because they are ill, but because they want to be well. They believe TCM helps them keep in balance. It’s an important lesson for doctors and patients alike to address wellness and prevention.

#5. Medicine is a life-long practice. Western medicine revers the newest as the best; in contrast, patients revere old TCM doctors for their knowledge and experience. Practicing doctors do not rest on their laurels. “This is a practice that has taken thousands of years to develop,” I was told. “That’s why you must keep learning throughout your life, and even then you will only learn just a small fraction.”

#6. Evidence is in the eyes of the beholder. Evidence-based medicine was my mantra in medical training, so I was highly skeptical of combinations of herbs that are supposed to have some curative effects. But then I met so many patients who said that they were able to get relief from Eastern remedies while Western treatments failed them. Could there be a placebo effect? Sure. Is research important? Of course. But research is done on populations, and our treatment is of individuals. It has taken me a while to accept that I may not always be able to explain why—but if it helps the patient, that’s what’s important. “In a way, there is more evidence for our type of medicine than for yours,” a TCM teacher told me. “We have thousands of years of experience—that must count for something!”

There is so much I have not covered about TCM. Its practices vary regionally, and no doubt, there are more and less capable practitioners (as there are in Western medicine). More research into TCM methods will be important. However, regardless of whether we Western doctors want to prescribe TCM treatments, we should recognize there is much to learn from Eastern medicine, including what it means to be a physician to really care for our patients. A month into my China trip, I, for one, have a newfound appreciating for Eastern philosophy and medical practice.

An Emergency Physician, on the Need for Primary Care Doctors

Bill M. is a 22-year old college student who has had asthma and diabetes since he was a child. He comes in with trouble breathing because he has no primary care doctor and is out of his inhalers. While he’s in the E.R., he also says that his diabetes hasn’t been followed for years, and now his blood sugars are out of control and he has new problems with his kidneys and his eyes.

Rani K. is a 46-year old who moved from India to take a research position. She has had dark stools for a month, and now feels intermittently lightheaded. Her blood counts are borderline low. She needs an endoscopy and further testing—tests that can be done as an outpatient, but she gets admitted because she has no primary care doctor and the wait for to see a new one is 103 days.

Annie K. is a 35-year mother of three who has an infection in her leg that will probably get better with antibiotics, but will need to get checked by a practitioner in two days. Her doctor does not have an appointment for a month, so she is told to come back to the E.R. for a wound check. Even with insurance, each ER visit will cost her $250.

I am an emergency physician. These are real stories of patients I see in the E.R. Patients like Bill come in with severe complications of problems that can be prevented or managed—if they had a primary care doctor to follow-up with. Patients like Rani who get admitted to the hospital or like Annie who get told to return because they need urgent follow-up—but have no primary care doctor available to them.

The dearth of primary care physicians is a serious problem facing the U.S. healthcare system. The deficit for doctors is astounding, with a predicted shortage of 100,000 physicians by 2020. This shortage is particularly acute in primary care fields and in underserved areas. The reasons are multifactorial, and have to do with historical policies limiting physician workforce as well as ongoing problems with reimbursement, lifestyle, and service inclination.

We emergency physicians will always treat all-comers to our E.R.s to the best of our abilities. Emergency physicians are a creative bunch, and already, we have created value in areas of greatest need, for example, with pioneering observation medicine units and starting urgent-care follow-up clinics. Still, we as a society need to recognize that to deliver really excellent medical care, we must ensure a robust primary care system, and take steps to strengthen our existing primary care infrastructure through coordinating and task-shifting medical care, reconsidering payment and incentives, and realigning medical education with societal need. Primary care is the backbone of our society, and here in the E.R., we see why it is so urgently needed, every single day.

6 Ways to Get Rid of Your Headache

Got a headache? You’re not alone. Headache is the most common symptom that patients go to their doctor for. Nearly 10% of Americans suffer from regular migraines, and nearly a third of people report having a severe headache within the last three months that interfered with their daily activities.

Here are 6 ways to get rid of your headache.

#1. Rest. Most people feel better after closing their eyes and lying down. This is a common treatment for migraine sufferers, and for people with stress-induced headaches. Most of us will benefit from a rest, so find a dark place and close your eyes.

#2. Relax. Even more common than a migraine is headache induced by tension. However, especially for those who are accustomed to living a stressful life, relaxing is easier said than done. So try various techniques. Head-stretching and breathing exercises may help, as can massages, yoga, and meditation.

#3. Drink. Water, that is. Dehydration contributes to headache, and this is a problem you can fix yourself Drink two glasses of water when you feel like your headache is starting; this can help to curb it before it gets worse.

#4. Exercise. If your head hurts, exercise may be the last thing you want to do. For some people, particularly those who may have tension headaches, exercise can really help their symptoms. Regular exercise can also help prevent headaches from occurring, so try to build in at least 30 minutes of aerobic exercise four times a week.

#5. Take anti-inflammatory medications. Tylenol and Ibuprofen can reduce headache symptoms. Take 650mg of Tylenol and 600mg of Ibuprofen when your symptoms first start. It’s OK to take these together, and to repeat in 6 hours if you need. Be careful that other products can contain these ingredients, in particular Tylenol (acetaminophen): check the label of other medications you’re taking to make sure you are not overdosing on it.

#6. Consider alternative treatments. Though there is no clear evidence that alternative therapies are effective for headaches, some people have great results from acupuncture, for example. Certain teas, such as peppermint and lemon-ginger, have also been associated with alleviating headaches.

Of course, it’s always important to be on the look out for more serious causes of headache, for example, sudden onset of the worst headache of your life, fever, numbness, weakness, vomiting, or other concerning symptoms. Know that everyone is different, and you should try various therapies to see what works for you. Finally, as with everything, prevention is the best medicine, so sleep well, de-stress, and practice other good lifestyle habits!

I welcome your comments! What are other things you’d like to know more about?

10 Things to Bring With You to Every Doctor's Visit

Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with you. Keep this checklist readily accessible; even if you’re going to the hospital for an emergency appointment, aim to take the following 10 items with you:

#1. A medical card. It would be ideal for every doctor to have a full list of your medical history, but our country is not even close to having a nationally accessible medical record system. To make sure your doctor has your information available, carry a card with you. You can find many cards that easily downloadable on the Internet where you list your medical problems, surgeries, doctor’s names, insurance, and allergies. Especially if you are seeing a coverage doctor or visiting the E.R., he or she may not have your medical record. This makes sure that your doctor can see your most critical medical information.

#2. Changes to your medical record. If you have had recent test results since you last saw your doctor, bring these with you. Even if it was your doctor that you’re going to see who sent you to get the test, bringing the results will make sure that they are discussed during the visit.

#3. Your medications. Very often, patients come in and say that they can’t remember what they’re taking. “I think I stopped taking the pink tiny pill, but I’m still taking the white one and the blue one,” is not as helpful as actually seeing the actual bottles with the labels on them. Take all your medications, put them in a bag, and bring them with you. Tell your doctor if you’ve stopped taking any of your medications, and be honest if you haven’t been taking them as much as you were supposed to. Otherwise, your doctor may assume they’re not working, and prescribe you even more!

#4. A list of alternative therapies. The majority of our patients use some type of alternative therapy. It is better for your doctor to know about it. Most doctors are not experts in herbal therapies, but it’s useful for them to know what’s your taking in case there are some interactions with your other medications. Keep a list of fish oil, vitamins, and supplements that you’re using, and a record of any visits to chiropractors, naturopaths, or other practitioners.

#5. A journal of your symptoms. If you have a chronic condition, or if you have a new symptom you’re concerned about, you should be keeping a journal that documents your symptoms and how it is throughout the days and weeks. Your doctor may also ask you to keep track of your response to treatments you’re doing at home. Sometimes, there are objective measures that you need to write down, such as your blood sugar. Bringing the journal with you to your appointment can help remind you of your story, and allows for your doctor better understand what’s going on and how your symptoms affect your daily life.

#6. A list of your questions. You should always come prepared with a list of questions to ask your doctor. Brainstorm the list well before your appointment, and have a concise list of questions, starting with the most urgent that you must get answered. Don’t leave your doctor’s office without asking them.

#7. A notebook and pen. This may seem obvious, but your doctor may not always have writing equipment readily accessible, and it’s important to have a notebook and pen to take notes. Write down things that don’t make sense, and ask for clarification. If there are words mentioned that you’ve never heard of, ask your doctor to spell them. At the end of the visit, ask for a verbal summary. Make sure you write down and understand your plan.

#8. A family member or a friend. Having someone with you will give you support and company during the appointment. As importantly, they can help remind you of your questions and concerns, and is another measure to help ensure your doctor answers all the questions that you have.

#9. A smartphone. Everyone seems to have some kind of smartphone device: an iphone, a blackberry, an ipad. There will downtime when you’re waiting. Use this time to look up what your doctor has told you. The smartphone also keeps you busy if your wait is particularly long!

#10. Some snacks. Often, there are limited food options are the doctor’s office, and you may be waiting for some time. Unless you’re told not to eat, or have a complaint that you’re not sure how it will go, having something on hand can help make you feel better.

I hope this list is useful for you as you prepare for your next doctor’s visit. Please give me feedback: what’s on the list that you find helpful? What’s not on the list that should be? And what would you would like to hear about next?

“Inappropriate Use of the E.R.”: A Story of How an Emergency Physician Needed the E.R.

As emergency physicians who are trained in acute resuscitation and thrive in high-stress situations, we tend to roll our eyes at the less acute complaints our patients come in with. “Back pain for three months? Headache for a week? Why are they here now?” Patients, too, complain about this. “Can’t they see it’s not a real emergency and go see their primary care doctor? This must be costing our healthcare system a fortune!”

A couple of months ago, something happened that made me question this so-called “inappropriate use of the E.R.” Let me tell you about a previously healthy young woman, an emergency physician, who came back from her shift at the Brigham & Women’s E.R. feeling a bit under the weather. She was a little nauseous, but was able to eat the Chinese take-out dinner that her husband brought back. Right after dinner, she went to bed, but couldn’t sleep because she developed a gnawing abdominal pain. Then, she began throwing up, and kept throwing up at least ten times in the next hour.

Being a physician, she came up with a differential diagnosis. This was most likely stomach flu: a simple viral illness. However, stomach flu generally involves diarrhea, which she didn’t have, and she really didn’t have other viral symptoms. It could be bad food, but her husband ate the same thing (and she, being Chinese, was sick of Chinese food always being blamed as the culprit). Any woman could be pregnant, and though the suddenness of her symptoms made that less likely, an ectopic pregnancy was theoretically possible.

So she set about to self-diagnose and self-treat. She sent her husband to the local 24-hour CVS to buy a pregnancy test and to pick up a nausea medication that she prescribed herself. The test was negative and the medication made her vomiting stop, but as the morning came, her abdominal pain was still there. In fact, it was now localized more to the right lower side, and it hurt her to walk.

I’m sure you see where this is going. You’re probably thinking to yourself whether you would have bitten the bullet and gone to the E.R. to make sure you don’t have appendicitis. Well, this young woman was me, and I was trying to avoid checking in as a patient, getting the radiation from a CT scan, and burdening our overtaxed healthcare system. Fortunately, I was able to call and find out the E.R. attending that day was an ultrasound specialist. She did me a favor to ultrasound me, and found that my appendix looked fine, but my intestines looked inflamed—consistent with stomach flu. I got my diagnosis, and over the next few days, I recovered with no radiation and my appendix intact.

Had someone like me actually checked in as a patient, I could see how there might be grumbling from the providers. “A young woman with stomach flu who’s actually getting better—why is she here?”  “If she doesn’t want a CT, why did she come to the E.R.?”

What I learned from this experience is that it’s always easy to say in retrospect that the patient didn’t have to come to the E.R. In the moment, when the patient is scared and in pain, it’s not so clear. Even as an E.R. physician myself, I couldn’t tell if what I had was something benign that would go away on its own (stomach flu) or an acute process that required urgent intervention (appendicitis). How can we expect our patients to know whether their chest pain is the same angina as usual or a heart attack, or whether their swollen ankle is a sprain or fracture?

My flirtation with the E.R. has made me more sympathetic to our patients who come in with seemingly “non-E.R.” complaints. It also has me thinking on the larger scale about proposed policies that impose penalties to our patients for using the E.R. Don’t get me wrong; there is a need for more primary care doctors, and our patients will benefit from increased access to primary care. However, patients don’t always know whether they have primary care versus emergency complaints. So I turned out to have stomach flu, something a primary care doctor can address. But had I been a “normal” patient, I wouldn’t have been able to treat my own symptoms and then walked into get a favor from a specialist physician—surely, I would have had to check into the E.R. to be seen. Would it have been fair to penalize me for that E.R. visit when it turned out that I had a less-than-emergent illness?

It’s important that our policy-makers consider that even well-informed patients with good access to primary care need the E.R. For our part, we as emergency physicians need to stop complaining about our patients and embrace our duty at the frontlines of medical care, sorting out all patient presentations and working to diagnose and treat all of our patients.

Portions of this article appeared in my column for CommonSense, the newsletter of the American Academy of Emergency Medicine. Thanks for reading; I welcome your comments.

6 Ways to Fight End-of Summer Blues

Summer is coming to an end. Feeling down around this time is quite common, especially for those of us who live in colder climates and can see the winter approaching. Here are 6 ways to fight those end-of-summer blues:

#1. Get sunlight. Seasonal affective disorder (SAD) affects up to 10% of people. You may not have full blown SAD, but use the same treatment—and the same preventive measures—to feel better. Soak up the sunlight. Open your blinds at home. Find areas at work that have natural light; perhaps take breaks in a room where the sun streams in or that’s near a skylight. Choose to walk the longer route on sunny days. Eat lunch in the park. Even if it’s chilly outside, the sunlight itself will help you.

#2. Exercise. Physical exercise alleviates stress and makes you feel healthier and happier in general. When you exercise, natural endorphins kick in that improve your mood. It may be particularly helpful if you exercise outside; a brisk power walk when it’s light outside will help you get fit, feel better, and soak up sunlight! Aim to have at least four-40 minute episodes of aerobic exercise per week.

#3. Eat summer foods. In the summer, we tend to eat healthier than in other seasons. Meals are filled with fresh fruit, raw vegetables, and big salads. Keep this up! Just because the weather is changing doesn’t mean we have to load up on the carbs. Aim to have three of these “summer meals” a week. Bring fruit and vegetable snacks to work instead of potato chips. Choose a salad over a carb-heavy lunch. A change in diet can help you feel significantly better.

#4. Sleep early and well. As it starts to get dark earlier, shift your schedule gradually to the earlier side. Make sure you are getting at least 8 hours of sleep every night. Waking up earlier helps you get more sunlight, and good sleep hygiene is essential to good physical and mental health.

#5. Keep reminders of summer with you. Display your pictures of summer vacation. Use lotions and scents with coconut and other summery smells. Light a scented candle, and break out the bubble bath. These little touches can make a difference.

#6. Make good plans for the rest of the seasons. Have some things that you are looking forward to in the fall and the winter. Perhaps it’s a vacation, or party, or other event--maybe it's as simple as viewing the fall colors. Celebrate the little things too, and treat yourself often. There are reasons to embrace the other seasons too! And if all else fails, summer isn’t that far the future again.

I'd love to hear your thoughts and comments about my blog and videocast. What do you use to combat those end-of-summer blues?