This article is from the WebMD Live Events Transcript Archive

Event_Moderator Welcome to WebMD. Today we will be discussing Being a More Informed Patient, with Stuart Fischer, M.D. Stuart Fischer, M.D., is one of America's leading health advocates. A specialist in internal medicine, Fischer has been a leader of the alternative medical movement in New York City and is a prominent health educator. His audio cassette, "Vital Signs," provides steps on how to become a more informed patient.

If you'd like to ask Dr. Fischer a question, please type /ask followed by your question.

Dr. Fischer, welcome to the show.

Dr_Fischer Great. Thank you.

events_moderator {question presented} How can a person be an informed patient?

Dr_Fischer I think that there are numerous ways to be a good patient and not all are necessarily based on information, but certainly information goes to the top of my list. Know exactly what you are being treated for. This may sound vague and obvious, but in my medical practice in NY, I have met many people who, under prior physician's care, actually don't know the illness that they are saddled with. This may take various specific forms namely, do they have a lung problem? Do they have a heart problem? Do they have gastrointestinal problem? People are often not specific. 

I begin every interview asking people if they have high blood pressure, diabetes, or any type of heart disease before I ask them anything else. This helps put things in perspective. A second way to be an informed patient is to have handy the phone numbers of the physician, the hospital, the ambulance services that are in your area and any other relevant practitioners. Not only should you be informed, but your other family members need to be informed of where to turn in case of an emergency. Third, being an informed patient means that you understand any medication you are taking...how it works and how it may have side effects. Most people other than perhaps a vague spelling of the medication name, do not fully understand the chemical interactions of drugs that they might be taking. Fourth, being an informed patient includes knowing if you have any laboratory abnormalities. For example, I usually ask diabetics how high their blood sugar has been when they were diagnosed. This tells me how severe their condition is. This bit of information may seem trivial to them. After all, it's just a glucose number, but it can often have profound implications, namely for that person's risk of heart disease. Fifth, being an informed patient especially today in the United States, means understanding your medical insurance. Very often people do not know what their coverage is. Perhaps the medication that the doctor wants them to take is $100 or more for a cold. This is not exactly unknown and certain hospital admissions and other practitioner's services, let's say cosmetic surgery, may not be covered under your insurance plan. You may not even be able to see me under your insurance coverage. People often don't know what that implies. That means that they are not able to make a choice of a physician and bond with that person. I find in my practice that there is a symbiotic relationship between a good physician and the patient. They help each other and they are both well informed about each other. Insurance unfortunately, which is concerned with dollars and cents or other types of currency, can be a very unpleasant variable in the equation of healthcare. As we know, many people have no medical coverage at all. As a side statement, being an informed patient without health insurance coverage means knowing what kind of trouble you can be in if something goes wrong. Ignorance is bliss for thousands of people across the country who think that they will deal with medical problems as they happen. If they are 20 years old, nothing could happen to them because they're young. Someone young can be in a car accident and wind up in a hospital with no medical coverage and this can be an extremely costly experience.

Event_Moderator Aren't we at a point where the insurance is so complicated that the insurance companies can take full advantage of people's ignorance?

Dr_Fischer It's a very good question but, in reality, I don't think that happens. A typical visit to a physician is pretty straightforward from an insurance point-of-view. I agree with you if you are concerned with someone extremely ill with possibly extremely expensive surgery or medical treatments. That's when insurance companies tend to get picky and to look into exactly what the patient's treatment consists of. Someone having dialysis or lengthy hospitalization would be scrutinized by every insurance company that I could think of, whereas, someone from Brooklyn coming to see me, Dr. Fischer, for a cold, this visit would hardly be questioned by the insurance company under usual circumstances. Most people run into insurance problems if they are ill or worse, if they have neglected a disease for a long time. My sixth point about how to be an informed patient is to be sure all questions are fully answered before you leave the doctor's office. When will I get better? Do I need a mammogram? Doc, is this cancer? I ask every patient, have I answered all of your questions? This is a time saving maneuver and I stress TIME SAVING. Very often patients are shy and very often patients have a vivid imagination. Any pimple on the face becomes cancer until the doctor says it's not. Number seven, keep a first aid book or a Merck Manual at home. A Merck Manual contains brief descriptions of the major illnesses of the over 40 crowd. The Merck Manual is not a textbook, thank goodness, and is not very complex, but it gives the reader hints about what to look for and what to do before the doctor visits. 

Number eight, know the signs and symptoms of heart disease. I worked for four years as an emergency room physician and I can tell you from firsthand experience that the families who knew signs and symptoms of heart disease brought their relatives to the hospital in good time. I also would like for patients to know CPR. Why is this? Because when people have a serious heart attack, it usually happens in the house, not in the hospital, not in the ambulance, not in front of the doctor. If we must know, 30% of all fatal heart attacks happen at home in the early morning. ...when people get out of bed. When we are lying down and sleeping, our system is at rest but when we stand up first thing in the morning, we activate the sympathetic nervous system. This amounts to a burst of adrenaline. Everyone knows this as we rush off to the alarm clock, off to whatever we have to do before work or play, AND the heart rate speeds up, the blood pressure speeds up and people with underlying heart disease, this may be fatal. This is why I stress that members of the family should know what to do in case of a cardiac emergency. CPR is not difficult to learn. Number nine in my list of how to be informed patient is to make sure that your doctor addresses diet, nutrition and exercise with specific recommendations. In the year 2010, the number of diabetics in the United States will double because we are getting fatter and fatter. In the last decade, each American gained an average of 8 pounds. This is the fattest civilization in history of the United States. Despite the internet and despite pioneering fiber optic surgery, people neglect their diet, nutrition and exercise and most doctors neglect this also. If you are following this program tonight on the internet, it has already lasted twice as long as the average medical visit in the United States in 1988. The average medical visit is 8 minutes long. Regardless of the severity of the condition. CORRECTION: The year should be 1998 (not 1988). Doctors tend to be rushed individuals often with poor diet and nutrition themselves and feel that exercise, nutrition and diet is not as important as prescription medication or surgery. If your doctor does not mention these things, you should! 

The tenth point is a very simple one. Have a medical exam at least once a year. I would say over age 20. I was going to see an internist at age 14. I'm an internist,  which is a doctor with a broad range of knowledge. The medical exam for someone 20 is obviously not the same as for someone 70, but the doctor should be able to decide which tests or examinations would be appropriate. These are my 10 general points on how you can insure yourself of better health, working with your caretaker physician and realizing that a great deal of the burden falls back on the individual him or herself.

Event_Moderator What are the laws governing pre-existing conditions?

Dr_Fischer It isn't a law as if it's written in stone but most insurance companies do not like to treat a freshly diagnosed illness. In other words, if I have no insurance coverage and suddenly I develop high blood pressure, the doctor will need to order many potentially expensive tests for me. If at that point, I shop insurance brokers asking for a good policy, most will be reluctant to get this expense. However, an insurance company beginning a relationship with an individual who is apparently healthy is a better proposition for them. Most people are relatively healthy.

Event_Moderator What about a condition that is not freshly diagnosed, but a little older?

Dr_Fischer Very good question. That is actually in most policies exempt. A condition that has been diagnosed in past one year is a new pre-existing condition. A brand new condition, one that would be very expensive to treat. Meaning, numerous blood tests, new medications, diagnostic x-rays, biopsies, hospitalization. Those are the initial steps in evaluating a new illness. However, an ounce of prevention is more than a pound of cure. ...as we were all taught. All of the major illnesses have ways of being prevented and diagnosed. You can check your blood pressure at home. You can check your blood sugar at home and your cholesterol too. In this way, the individual may monitor their own health or illness. I'm only referring to two major illnesses. Fortunately in year 2000, we have stress tests, EKG's, colonoscopies, and other diagnostic tests that can hopefully locate the two major villains, heart disease and cancer. These two villains account for 90% of the deaths in the United States. It would be good to forestall them as long as possible. It is not something that is done passively. A good patient is an active participant in his own healthcare. A good patient is not a scientist. I know that my patients have a broad range of educational experience and insights into their bodies. ...but I firmly believe all people can understand all conditions at least on a basic level. In past years, in my over 300 radio broadcasts, I have found that people can be taught about the workings of the human body. ...even if they have not had college biology. I also believe it's extremely important and practical information especially if one goes back to something I mentioned before, the signs and symptoms of heart disease. Maybe you know that a heart attack often gives a patient a strange sensation in their left arm. ...or in their neck, or in their lower jaw. Maybe you don't. One day someone you know may have a heart attack right in front of you and have one of those symptoms. Would you know that this person needs to be rushed to a hospital? That's what I feel is one of my greatest ambitions in life, to teach people about the signs and symptoms of human illness. They do not need to understand complex cardiac anatomy. Even I don't know it all. 

Actually it varies from person to person. People and their illnesses are as different as different can be. Being a good patient also means wanting to get better. Some people don't want to get better. Some people don't care about their weight. Some people do not take their cardiac medications correctly. Being a good patient means doing what is asked of you on a daily basis in all aspects of your life.

Event_Moderator What are some of the steps I can take to prevent heart disease and cancer?

Dr_Fischer Very good question. To prevent heart disease, one should look in the mirror and examine one's own weight, diet, blood pressure, cholesterol level, stress level and nutritional status. If they are all up to par, one's risk for heart disease is greatly diminished, but if you are a diabetic and millions of Americans are, about 16 million Americans have diabetes and these people have a tremendous increase in heart disease risk even if their sugar is normal. Why? Their cholesterol is abnormally thick. I inform all of my patients whenever I do their blood tests on their cholesterol, good cholesterol ratio. This is a very good clue on the individual's chances of serious narrowing of the coronary arteries. Unfortunately, I feel that there are probably over 100 risk factors for heart disease, not just smoking and obesity. We should all be so lucky that serious illness like cancer or heart disease can be explained by four or five simple facts. Human illness is very complex.

Events_Moderator {question presented} I try to eat well, and I don't have a whole lot of fat in my diet, but my cholesterol is quite high. Why is that, and how can I get it down?

Dr_Fischer Eating well to you may not be eating well to me. Many people eat an abnormally high percentage of carbohydrates in their diet thinking that the absence of fat will lead to the absence of heart disease. As it turns out, this may actually raise many people's cholesterol and raise it dangerously. We are all subject to the biochemistry determined by our genetic make-up. Cholesterol and blood pressure and blood type and freckles are all part of this.

Event_Moderator Freckles?

Dr_Fischer The number of melanosomes (pigment patches in our dermis) -- many people have more melanosomes than others. To jump to an entirely different area, many of us may have poorly developed kidneys because of protein malnutrition when we were developing. This abnormality in kidney function is now known to be a factor in the development of high blood pressure. And, as if we did not know, stress can effect every illness known. Stress plus high blood pressure equals even higher blood pressure. Stress plus coronary disease equals plugged up arteries. Stress plus ulcerative colitis equals rectal bleeding. ...and so on. Another important factor is our diet. Americans eat 5 times more sodium than our ancestors. Our body was originally developed for a very low sodium diet. Therefore, how we eat from day-to-day may actively change the disease process.

Events_Moderator {question presented} What effect does stress have on my physical health?

Dr_Fischer Stress, I believe, can only have a negative effect. Stress, I tell my patients, is like taking steroids. ...prednisone, for example. What do steroids do? They raise blood pressure, they make people diabetic or pre-diabetic, they cause blood sugar abnormalities which can cause people to eat improperly. ...and can affect the amount of adrenaline in the bloodstream. Stress, by the way, is responsible for 50% of skin disease. I was taught this at the Bellview Dermatology Clinic, one half of rashes, all skin problems are psychological. One half of all doctor visits are psychological. I pride myself on my humanistic insights which come from my background in psychology which I studied at Yale University.

Event_Moderator Do you mean that the patient thinks there's something wrong with them or what is wrong with them is psychological in origin?

Dr_Fischer Either/or. Very often people will have a fight with their spouse, a problem at the job, one of the kids might be misbehaving and the person may report to the doctor's office not realizing that it is the stress causing abdominal pain, migraine headaches...various skin rashes. There is a skin rash called Cholenergic Urticaria. These are little bumps all over the skin, very itchy, particularly at night, totally psychological. What is the stress that causes it? It varies from person to person and what might be stressful for person A may be a minor issue for person B.

Events_Moderator {question presented} Are emotional and spiritual health a part of physical health?

Dr_Fischer Yes. Emotional health is the most important aspect of living. Physical health is a tool to achieve emotional health. Just being physically healthy is not as important as our happiness in our lives, our sense of accomplishment, our social relationships. This is the most important thing of all. Physical health and one's insights into one's health are a necessary path to achieving this. That's an excellent question.

Event_Moderator How does alternative medicine help us to become a more informed patient?

Dr_Fischer I am in the alternative medical community now for 12 years...and consider myself a distinguished practitioner. Alternative medicine focuses on the patient's responsibility of knowledge and the patient's ability to manipulate their health to his/her advantage. For example, taking vitamins. When was the last time your doctor told you exactly which vitamins to take? Only alternative practitioners address this issue. When was the last time that your medical practitioner asked if you were happy? I do this in my daily practice. I look for the practical ways to get the individual to a better emotional state. One can never be too happy.

Events_Moderator {question presented} Do you recommend any particular diets?

Dr_Fischer I recommend numerous different diets for different conditions and for different individual types within those conditions. A business man or a homemaker or an 85 year-old senior citizen or a 20 year-old, all of whom may have high blood pressure, may need 4 different diets. 4 different types of nutrition, 4 different exercise routines that are realistic for them and possibly 4 different types of medication. Diet needs to be individualized and one must be realistic about what the individual will follow. Setting goals for the patient that the practitioner knows are impractical or too expensive are very foolish. I like to give people recommendations that I know they will do.

Events_Moderator {question presented} How much exercise do people need?

Dr_Fischer Nowadays people need to exercise more than in the past. Why is that? We are a sedentary society as both you and I are now proving. Our ancestors sweated much more. Sweating leads to sodium loss which lowers blood pressure and edema. If we were more active, we would have much less diabetes and heart disease. Here's an interesting fact: To lose one pound of body fat, you need a caloric deficit of 3500 calories. ...or 500 calories per day. Can most people achieve this? No!!! After all, a bagel with cream cheese is 500 calories. Most people look for an easy way out. The current recommendation for exercise is no longer 30 minutes of aerobic exercise three times a week. Here comes the bad news: it's 60 minutes of aerobic exercise 3 times a week. I can fit this into my schedule as a Manhattan based physician. Can you? I hope so. I wish it were otherwise. This is a simple recommendation which most people unfortunately cannot or will not do.

Event_Moderator Is there still a percentage of the doctors out there who are resistant to their patients' taking control of their bodies or would they rather have patients who are more passive?

Dr_Fischer Yes. I believe that for many non-holistic physicians, helps the power trip relationship that most doctors need. This also applies to lawyers and stock brokers too. An informed client of one in any profession can often be upsetting to the provider of information. And as I mentioned earlier, most doctors will only spend 8 minutes with you and if in those 8 minutes, they have to do enough talking to make it worthwhile. They'll be right out the door at the end. I do not like this at all. I do not do this at all.

Event_Moderator Do you feel that the amount of information that is available to the average patient, say from the Internet, will change the course of medicine?

Dr_Fischer Probably not. Why? Because the relationship between a skilled physician and a patient requires a physical encounter. I do not diagnose myself after over 20 years in the profession, I require someone else's set of eyes and ears. Medicine is an art. The information is one thing but one cannot learn how to play the piano over the internet. There are many other things one cannot do, and unfortunately, I have seen patients not treated well because they lacked the physical encounter between a skilled healer and themselves.

Events_Moderator {question presented} How can I relax? My job is really stressful.

Dr_Fischer This is the trillion dollar question. You may take advantage of any number of therapies, medications, herbs, exercise programs which reduces adrenaline. It has to be individualized. My job is stressing too but I have learned how not to take it home with me.

Events_Moderator {question presented} I can't sleep at night because my job is so stressful. How can I leave work problems at work?

Dr_Fischer This is exactly what I address in my practice on an individual basis. It requires a long discussion with a healer with empathy. However, for all those of you seeing this question and thinking it doesn't apply to you, many of you are wrong. Many of you think you are not being stressed by your family, friends and job. Check your blood pressure. Check your EKG. I will refer people to an excellent audio cassette series that I have done. It's 15 audio cassettes on variety of medical topics, many of which I mentioned today and they are available through American Reporters at the following phone number: 1-888-31RADIO. These are 15 of my best lectures from my years of radio broadcasting. All are understandable by the layman and all are highly acclaimed by my listeners and patients.

Event_Moderator Do you have a web site?

Dr_Fischer Not yet. Soon.

Event_Moderator Thank you for joining us, Dr. Fischer. Please join us again tomorrow at 1:00 p.m. EST in the Senior Vitality Auditorium, where we will be discussing "What Your Doctor May Not Tell You About Menopause," with John R. Lee, M.D.

Dr_Fischer I'll be back on in two weeks. I'll be discussing 10 important health tips for year 2000. This was truly excellent for me. It's a pleasure.