What Empowered Patients Can Learn from the Car Repair Guy

When it comes to maintenance of our cars, we here in the Midwest take the annual winter checkup seriously. If the car does not start, that can be an inconvenience. But if it is 30 below zero with wind chill, and we are on an isolated country road, that inconvenience could turn deadly quickly.

From some ominous experiences, I faithfully bring our automobiles into the dealership in October for the usual “10-point checkup.” The mechanics check the usual stuff of tire pressure, windshield wiper fluid, battery life, and those sorts of issues. Or so I thought.

After this last visit, when checking the oil while getting gas, I glanced at the reservoir for the antifreeze. The fluid level was at zero rather than the usual 100% mark on the container under the hood. I am hardly a “gear head,” but I returned to the dealership and had the appropriate fluid added.

I was not a particularly happy camper when I asked the service manager about this oversight.

He rather tersely replied, “Well, you didn’t ask to have it checked.”

I thought these items were part of a routine checkup. But now for the lesson.

On a far more serious note, many patients are completely clueless about what they should expect during the evaluation of a health issue or concern. Most cannot be expected to have any insight about the usual procedures to monitor a condition, or any condition. Nor can they be expected to have a reasonable understanding of the natural history of their diagnosis.

For example, if someone is diagnosed with dementia of the Alzheimer’s type, a physician, typically a neurologist, can outline for the patient and the family the anticipated natural course of that condition. But let me get specific.

A beloved family friend, a woman in her midsixties, lived in another state and was traveling through our community on her way to see a family member. It was a wonderful time to reconnect before the holiday frenzy began. Yet, she looked gaunt, and I noticed a weak handshake and general unsteadiness.

She then shared with us that about a year ago she had a serious fall down a flight of steps while carrying some groceries. And almost became a quadriplegic. She had superb neuro surgical and nursing management but clearly lost dexterity in her hands and upper extremities and had profound muscle wasting, which can be typical following a major spinal cord injury.

During the postoperative recuperating period, she had some basic and short-term occupational and physical therapy, but this was sporadic because the major focus was on the postoperative recovery.

Our friend stayed several days with us and was stunned when she saw our home gym with resistance bands, exercise balls, and schedules for daily workouts of various intensities. I inquired about her own post-hospital physical therapy as well as occupational therapy and was dismayed that following dismissal from the hospital, these crucial specialties were never offered to her.

Like the service manager who said to me, “You didn’t ask for it,” she was not knowledgeable enough to ask for these services.

I am not a savant, but with an aggressive physical therapy program I would have anticipated some improvement in muscle mass and strength and greater dexterity in manipulating a knife and fork. These interventions are almost always much more effective when they start early in the patient’s postoperative care, but here we are a year later, and I would surmise that the recovery may not be as robust.

So just like when you check the oil and fluids in your car, consider these items as part of your physical checkup:

• Ask the healthcare team whether in a hospital or outpatient setting, what are the usual and typical interventions following a diagnosis of X, Y, or Z. If a patient has had a myocardial infarction (heart attack) there are well-established cardiac rehabilitation programs. If a patient has had a stroke, there are also well-defined post-stroke interventions to maintain mobility including speech and cognitive functioning. If a patient has gone through addiction recovery, appropriate follow-up programs are essential.

• Insist on being evaluated for these postoperative programs. Get referrals to community providers.

• We as patients have a right to speak up and be offered the opportunity of ancillary integrative services that might enhance our recovery, or that might slow down the disability from becoming a potentially serious event.

• Phrase your request like this: What types of therapy can I do now to improve the outcome of this condition? Where can you refer me for this therapy?

From Wix Media.