"Hmm, that's fine. Hmm, that looks OK. Hmm, we may need to check that on your next visit ..."
As you put your clothes on, it strikes you: You have no idea what the doctor is saying or why he's saying it. All you know is that it's about you.
But maybe you should know the details. With so many hands determining your health care -- insurance companies, employers and your doctor -- you want to have some modicum of control. That means knowing what they know. And getting copies of your records and asking for better explanations from the doctor may not help if you don't know what you're looking for. So here's a primer:
Health care: The basics
Health care is delivered in three basic forms:
This includes screening, checkups, questions and a lot of laboratory work. This is why it's good to stay with the same doctor for a while. A good doctor watches changes that come with age and other factors. He can monitor you best if he watches you for years.
The younger you are, the more a doctor is concerned with prevention. Cut back on alcohol. Eat right. Exercise more. Wear your seat belt. Stay married.
As you get older, doctors check for specific maladies that come with age -- blood-pressure fluctuations, cholesterol levels, blood-sugar levels, signs of cancer, bone density and so forth.
When the doctor walks into the treatment room and asks, "How are you feeling?" that's not a greeting. Feel free to tell him anything and everything.
Most illnesses are what they seem to be. Coughs and sneezes are probably from colds or allergies. Nausea is probably from a simple upset stomach. But a cold could be a sinus infection. A stomachache could be an ulcer. And then there are those weird pains and feelings.
"I'd say about 20 percent of the cases I see, we never figure out where (the problem) came from," said Dr. Mark Mengel, professor of family practice at St. Louis University School of Medicine.
Once an illness is identified, you get medicine, surgery, physical therapy or outpatient combinations of all of them.
You should know information about your body in order to avoid getting to the point of diagnosis and treatment. So you need to start early in life, keeping an eye on the numbers for prevention, doctors say.
"People are living longer and want a better quality of life as the years tick by," said Dr. Mark Gregory, an internist with Washington University School of Medicine. "People are more attuned to preventative health care than they were even a generation ago.
"Now they're looking to optimize their health and their life experience. A generation ago people wouldn't go to the doctor just to get a checkup." Now the goal is to enjoy life, "and not be saddled with the dread diseases they've seen their friends and family go through."
In his years of medicine, Gregory says he's seen consistent characteristics in people who do well in life. "One of the fun parts of my job is to have a window on humanity," he said. "You get a real picture."The picture he gets of well people:
- All of them exercise a lot. "Take seriously how much exercise can help you live a healthy life," he says.
- They all are fairly happy in their work and find meaning in it.
- They all seem to have a stable home life, single or married.
- "And they're all skinny," Gregory said, "even people who are in their 70s and 80s."
Know your risk factors
Doctors who teach doctors say they're happy to talk over numbers and information with patients. With the emphasis on prevention and living well into old age, much is in the hands of patients. And doctors say if there's one piece of advice, it's know your risk factors.
Dr. Mark Mengel, a professor of family practice at St. Louis University School of Medicine, stressed that patients need to know that a doctor looks at numbers, tests results and other information in context.
"It's not one number," Mengel said. "When a doctor is looking at the numbers on a chart, he's looking at risk factors, family history, what's the person taking, what does the person need today in terms of interventions."
These are the primary risk factors doctors look at on your office visit:
The biggest risk factor. Mengel explained that your family history of disease is the biggest indicator of what may happen to you in the long run. Cancer, heart disease, stroke -- many things can run in the family. That includes bipolar disorder, migraine headaches, even rare diseases.
BMI and body fat percentage
Know your body mass index to gauge if you're officially overweight or obese. BMI is a ratio of height to weight. More than 25 is overweight; more than 30 is obese. Research has found that being overweight or obese is the gateway to a myriad of diseases, and makes other diseases worse. Use a BMI calculator to find your BMI.
Be aware that the BMI is generally useless for athletes. People with high muscle density may weigh enough to be classified as obese yet be in splendid physical condition. A more reliable gauge is body fat percentage. Generally, more than 25 percent body fat for men, and more than 36 percent for women, is a risk factor, according to the NIH.
Local gyms test for body fat, and scales that measure body fat are available in catalogs and department stores.
If there's one running number you need to know, it's your blood pressure. It's essential to keep a log. Blood pressure is called the silent killer because it has no symptoms until a blood vessel fails and damages a major organ. That can mean heart attack, stroke, kidney failure or other damage.
Blood pressure must be monitored over time -- months, even years. One reading won't tell you much. Blood pressure changes from the time you're asleep to the time of road rage on your commute to work.
The NIH has issued these guidelines for blood-pressure readings:
- 120/80: Considered normal, although it's on the high end of a healthy blood pressure, not an average. Some elements of the medical community are pushing for 115/75 to be the new gold standard. The first number -- the systolic -- refers to pressure when the heart pumps; the second number -- diastolic -- refers to when the heart is between pumps.
- 139/89: The high end of a condition called prehypertension. You should take steps to lower your blood pressure or you're probably destined for hypertension.
- 140/90: Hypertension, or high blood pressure. Continue in this condition and the doctor will put you on medication.
- 160/90: Stage 2 hypertension. The doctor will put you on stronger medication.
You have two types of cholesterol: HDL (think H-happy), which is good, and LDL (think L-lousy), which is bad. The company line is that if the combined numbers are above 200, that's too much.
But that's not always true. HDL can be high if you're taking a lot of fish oil tablets or other supplements high in omega 3 fats, if you have no red meat in your diet and eat only fish, or if you're genetically predisposed to use HDL efficiently. In unusual cases, HDL can be high enough to push the combined numbers close to 200 or even over slightly.
Doctors like to see HDL above 40 and LDL under 100. When a doctor starts you on cholesterol medicine it's because your LDL is too high, not strictly because your combined numbers are above 200.
Temperature is a red flag for when you need medical help. Knowing your long-term temperature is important: Do you burn hot, cold or average? Average is 98.6 degrees, but some folks are above or below that naturally. If your temperature comes back as 99.1 every time you take it for years, that's your temperature. If it goes up, your body is dealing with something.
Your waist circumference
A measurement greater than 40 inches for men and 35 inches for women is a risk factor; added to other risks it's called "metabolic syndrome" -- a mix of health risks.
By the time you're 50 -- or younger for black people -- you should start getting checks for colon, breast and prostate cancer. While race is a factor, doctors say black people can have even more trouble with cancers because they wait too long for their screenings. Also, smoking seems to be a catalyst for these cancers and lung cancer.
You should have a colonoscopy when you're 50 -- earlier, if family history or other factors dictate, or if you're black.
Mammograms should begin at 40 for most women; some doctors suggest 35 for black women, and those with a family history of breast cancer.
The PSA test for prostate cancer should be done at 50 for most men and 40 for black men. Regular prostate exams are needed, especially for black men, who tend to get prostate cancer earlier and die sooner.
Track your blood sugar level over time with a fasting glucose test. Generally, the number should be between 70 and 99. More or less means the blood sugar is spiking too high or falling too low.
Pap smear results
Ask your doctor to interpret the timeless phrase, "Everything looks normal." All tests and evaluations are on a scale. There is such a thing as high normal and low normal.
The National Institutes of Health says you should have the test within three years of first having intercourse or no later than 21. At that point, get an annual test until 30 years old. If you've had no risk factors by 30 or had normal results for three consecutive years, get retested every two to three years. After 65 get tested if you haven't been tested for several years. You might stop testing after 65 if you have three consecutive years of normal tests. If you've had a hysterectomy that removed the cervix you may be able to stop, but the doctor might suggest continued screening.
The U.S. Preventive Services Task Force recommends that women 65 and older be screened routinely for osteoporosis. That can start at 60 or even earlier for women who have extra risk factors: lower body weight, smoking, weight loss, family history, decreased physical activity, alcohol or caffeine use and low calcium and vitamin D intake.
If exercise is the most important thing to do, smoking is the most important thing to stop doing. Smoking can damage every organ in your body from the lungs to the skin. If you don't stop smoking, your doctor will consider this a severe risk factor.
Research changes almost daily on what's safe and what's not safe to drink. The estimates run from a maximum of three drinks of anything a week, to one glass of red wine a day. Most researchers agree, however, that having two drinks a day or more is unsafe and a risk factor.
Sources: Dr. Mark Mengel, a professor of family practice at St. Louis University School of Medicine; Dr. Mark Gregory, an internist with Washington University School of Medicine; National Institutes of Health; Medline; MayoClinic.com.
You have a right to your medical records
Be aware that you have a right and even an obligation to know anything you want about your condition from people you pay for care.
Your doctor is required to give you answers, or at least the paperwork. That's a regulation from the Health Insurance Portability Accountability Act.
Charles B. Inlander, co-author of Family Health for Dummies (Hungry Minds, 408 pages, $19.99), says it's only courtesy to pay reasonable copy fees -- 50 cents a page. But beyond that, you are allowed to know every fact and figure the doctor knows, whether you understand it or not.
"Everyone in America has a right to their medical records; not a single state prohibits access to records," Inlander said.
"If your doctor won't discuss your health with you, you need to change doctors," said Dr. Mark Mengel, professor and chairman of the Department of Community and Family Medicine at St. Louis University School of Medicine. "We want patients to be concerned and be responsible for their health. We want them involved."
In addition, consider getting a new doctor if your physician:
- Gets cranky when you ask.
- Complicates things by requiring you to set specific dates or does anything else that hampers your seeing your records.
- Charges exorbitant copying fees.