June 2013

How To Make Rational Health Care Decisions

When it comes to your health, you want to make smart decisions. So, like the smart patient you are, you go looking for information. Good for you! But there’s so much information these days – it’s everywhere you look, and so much of it is frightening, or contradictory. The result: You may over-react to what you read and wind up having trouble making rational decisions.

Just look at how hard it is to be informed – but not make yourself crazy — after breast cancer. The whole process of being diagnosed with breast cancer and then getting treated is, of course, traumatic. As a result, every one of my patients dealing with it have become avid readers, and they are trying to do whatever they can to prevent a recurrence.

But this can make a person a little crazy. As an example, the use of soy after a diagnosis of estrogen sensitive breast cancer is not recommended. However, there is no evidence that it is dangerous. The rationale is that soy contains plant estrogens that could potentially stimulate estrogen receptors in breast tissue and cause a recurrence. Many of my patients and friends avoid all soy, even if there is a tiny amount in medication capsules.

These same patients will drink two or three glasses of wine a night, which we know increases the risk for breast cancer. Multiple studies have confirmed that more than one glass of wine a day increases breast cancer risk by one and a half times when compared to non-drinkers. My patients also may eat high-fat cheeses and other dairy products. This also has been found to increase breast cancer risk, because of the concentration of animal estrogens in fat.

Other patients may never let a bit of tofu or soy milk pass their lips, but get lax about exercise, when we know that working out just 30 minutes a day can decrease breast cancer risk by at least 18%.

I am not saying that it is okay to go out and eat unlimited soy. What I would like to point out, however, is that a logical approach to maintaining wellness is important. Regardless of your medical issues, speak with your doctor about what types of behaviors and habits will help you to maintain your health, because your doctor can assist you in forming a rational plan that will work for you.

Since there is a boatload of medical information from so many different sources, we all need help in sorting it out. Knowledge is power, so access it (in a rational way)!

“One of the first duties of the physician is to educate the masses not to take medicine.”
Sir William Osler

How To Stay Safe At the Dentist’s Office

When it comes to our medical care, we take a certain level of safety for granted. We figure our doctors and dentists take basic steps to avoid causing infections – like washing their hands and cleaning their equipment. But sometimes news stories remind us that healthcare professionals don’t always live up to those standards – and we start to wonder how we can protect ourselves.

I just heard about a colonoscopy center in Atlanta that failed to adequately sterilize its equipment. No infections have been reported so far, but the news comes on the heels of the shocking story of an oral surgeon in Tulsa, Oklahoma, who exposed his patients to hepatitis C and HIV because he inadequately sterilized his equipment. “Inadequately sterilized” barely covers it: W. Scott Harrington’s equipment was apparently visibly rusty, and he re-used old needles. He also used unlicensed employees to start IV’s to sedate patients. So far, 70 patients have tested positive for hepatitis C, five for hepatitis B and three for HIV.

These are frightening numbers, and the situation doesn’t get any more reassuring when you realize that random inspections of dental offices are not routine in every state. In Oklahoma, for instance, they’re not done unless there is a complaint; procedures vary by state.

Here’s what makes things even worse: Harrington’s office appeared clean, and apparently he is a likeable guy. So how should his patients have known that he was exposing them to other people’s blood and saliva? How do you know if you are safe in your dentist’s office?

The short answer is that you don’t! Not just by looking around. But the long answer is that you can find out by being observant and asking some questions.

Make a Call
Do your homework: Check out your dentist with your state Dental Association. They will tell you whether there have been any infractions or complaints.

Take a Look around Your Dentist’s Office
– Is it neat and free of clutter? A messy office with lots of papers lying around cannot be adequately sanitized.

– Are the floors carpeted? Carpet cannot be sterilized, but linoleum can be.

– Do the employees wash their hands in front of you before they put on gloves? This is essential. There should be a sink in each patient area with a soap dispenser.

– Are employees pulling the gloves from a package, or are the gloves just hanging loose? You want them coming from the box or package.

– Do they wipe down their equipment with disinfectant before using it? My dentist’s employees always disinfect the overhead lamp, chair and anything that is going to touch me (or them, for that matter). And they do this before I sit down, so that I know it has been done.

– Does every patient area have a sharps container for needles and sharp, disposable instruments? You’ll generally see these attached to the wall (they’re usually bright red).

– Do the instruments come out of a sterilized package or a wrapped tray? Do they have a sterilization strip on them? This is critical! If they don’t, you can’t count on them being sterile.

Then Ask Some Questions
Ask your dentist or his or her employees how they know things are actually sterile. Have them explain how the sterilization strip works (here’s a primer: The strip goes into the sterilization unit with the equipment, and changes color when it gets hot enough for long enough, signaling that everything is sterile). If they do not want to answer, or if they get squirrely on you, walk out.

Do they have a sterilization or autoclave record? There should be regular checks to make sure the process is working. You can ask to see the record.

The last question may be the most important of all: Ask your dentist what precautions he or she has taken to keep you safe. If you don’t get an adequate answer, or if your dentist gets defensive, find someone else.

Fortunately, Dr. Harrington is very much the exception among dentists, and infections like those in his practice are rare. However, his case reminds us that it never hurts to be cautious, and that it’s perfectly fine to ask questions. That’s true no matter what kind of health professional you’re seeing. Whether you’re getting a tooth filled, taking your child for a check-up, or having a colonoscopy, use your eyes and ears to protect yourself.


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