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Doctor confidence necessary part of quality care
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DEAR DR. ROACH: I have great confidence in my doctor, but my friends and family are concerned about my medical care. I’m in my late 60s, fit and enjoy good health. I have high blood pressure, which is now well-controlled with one pill a day. Last year, my annual physical was very cursory, and my doctor didn’t give me an order for blood work. I don’t know if it was an oversight or whether he is cutting back on health-care costs. I plan to bring this up at my next exam, but would like to hear your thoughts. --R.E.

ANSWER: I, too, am concerned that your doctor might not be giving you the attention you need. A once-yearly exam may be appropriate, but it must include a careful physical exam and a detailed history. It is usual to check blood tests at least once yearly in people taking blood pressure medicine. Hypertension can affect the kidneys, and many of the medicines used to treat it can affect mineral levels. Any imbalance may need to be treated. But what is most important is that you have doubts that he is acting only in your best interests. If you don’t get a satisfactory answer at your next visit, it might be time to look for another provider.  

DEAR DR. ROACH: In a recent column, you addressed a reader who noticed an improvement in IBS symptoms for a few weeks following a colonoscopy. While I agree that the reported improvement may be due to a change in colonic bacterial flora, it also may be due to the well-known phenomenon in IBS patients that just about any “treatment” will have some positive effect on symptoms for some duration of time. 

An interesting example of this was published in 2010. In brief, participants were given a placebo and told as much, yet still reported improved symptoms for a few weeks. 

I’m not against probiotic use, but given the mixed results (at best) and the cost to the patient, I find it more helpful to reassure patients with IBS that their symptoms will ebb and flow with various changes in their lives, diets, stress levels, etc., and to not get too invested, emotionally or financially, in any given treatment approach. -- Michael McCusker, PA-C 

  ANSWER: I thank Mr. McCusker for his thoughtful comments. The placebo response is powerful, and I am reminded of it nearly every day when I hear testimonials for a treatment that studies have proven to be no more effective than placebo. I am sure the person felt better after the treatment, but I’m not convinced that anything in the treatment was effective beyond the person feeling convinced he was getting better. I am all in favor of treatments that make people feel better, as long as they aren’t toxic or, as Mr. McCusker states, too expensive.

  In the case of probiotics in irritable bowel syndrome, most but not all studies have shown that they are superior to placebo, which is what the Food and Drug Administration demands before approving a treatment. I agree completely that symptoms of IBS often wax and wane, and that it is wise to be slow to add new treatments and to have patience. Probiotics are a potentially useful therapy for people with persistent symptoms.

  READERS: The booklet on asthma and its control explains this illness in detail. Readers can obtain a copy by writing: Dr. Roach Book No. 602, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

 DEAR DR. ROACH: I have great confidence in my doctor, but my friends and family are concerned about my medical care. I’m in my late 60s, fit and enjoy good health. I have high blood pressure, which is now well-controlled with one pill a day. Last year, my annual physical was very cursory, and my doctor didn’t give me an order for blood work. I don’t know if it was an oversight or whether he is cutting back on health-care costs. I plan to bring this up at my next exam, but would like to hear your thoughts. --R.E.

ANSWER: I, too, am concerned that your doctor might not be giving you the attention you need. A once-yearly exam may be appropriate, but it must include a careful physical exam and a detailed history. It is usual to check blood tests at least once yearly in people taking blood pressure medicine. Hypertension can affect the kidneys, and many of the medicines used to treat it can affect mineral levels. Any imbalance may need to be treated. But what is most important is that you have doubts that he is acting only in your best interests. If you don’t get a satisfactory answer at your next visit, it might be time to look for another provider.  

DEAR DR. ROACH: In a recent column, you addressed a reader who noticed an improvement in IBS symptoms for a few weeks following a colonoscopy. While I agree that the reported improvement may be due to a change in colonic bacterial flora, it also may be due to the well-known phenomenon in IBS patients that just about any “treatment” will have some positive effect on symptoms for some duration of time. 

An interesting example of this was published in 2010. In brief, participants were given a placebo and told as much, yet still reported improved symptoms for a few weeks. 

I’m not against probiotic use, but given the mixed results (at best) and the cost to the patient, I find it more helpful to reassure patients with IBS that their symptoms will ebb and flow with various changes in their lives, diets, stress levels, etc., and to not get too invested, emotionally or financially, in any given treatment approach. -- Michael McCusker, PA-C 

  ANSWER: I thank Mr. McCusker for his thoughtful comments. The placebo response is powerful, and I am reminded of it nearly every day when I hear testimonials for a treatment that studies have proven to be no more effective than placebo. I am sure the person felt better after the treatment, but I’m not convinced that anything in the treatment was effective beyond the person feeling convinced he was getting better. I am all in favor of treatments that make people feel better, as long as they aren’t toxic or, as Mr. McCusker states, too expensive.

  In the case of probiotics in irritable bowel syndrome, most but not all studies have shown that they are superior to placebo, which is what the Food and Drug Administration demands before approving a treatment. I agree completely that symptoms of IBS often wax and wane, and that it is wise to be slow to add new treatments and to have patience. Probiotics are a potentially useful therapy for people with persistent symptoms.

  READERS: The booklet on asthma and its control explains this illness in detail. Readers can obtain a copy by writing: Dr. Roach Book No. 602, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.