Dr. Evans explains the best way for a woman to advocate for herself after a stroke.
It’s overwhelming, to say the least, for somebody who has just had a stroke or has had a warning of a stroke called a TIA. They see a flurry of doctors in the hospital; they go through enormous number of tests, and sometimes the answers seem like they are not forthcoming immediately. And so, I think it’s critical that patients quickly develop a strategy of how they are going to address their problem and take ownership of their own healthcare issues so they can understand and really engage their doctors as partners rather than being passively led through the rest of their care.
The quarterback for stroke care really should be the patient’s neurologist, and that starts in the hospital and it continues into the rehab environment. So certainly for a patient or for the family, knowing which of the doctors is the neurologist and being comfortable asking both the neurologist and the other doctors, “How does whatever you are doing relate to my stroke risks? What are my risks? How are you modifying them? What medications are you using? What tests are we doing? What is our long-term plan?”
I think the idea of building timelines. Good doctors should be able to provide timelines for patients of what’s going to happen over the next few hours, what’s going to happen over the next few days, the next few weeks and the next few months, and that’s appropriate at almost every level. When we first start out it’s what’s happening right now, and soon, in the next couple of days, it’s what’s happening over the next few days in terms of my rehabilitation.
What helps patients keep that organized is having fairly detailed records. The ones that are absolutely critical, is knowing what test you have had, and if at all possible, getting your own copies of the results of those tests that you can keep in an individual binder. So, for example, if you have an MRI on Tuesday, getting copies of the reports of that MRI with the date and which doctor did it so that it’s available for you to present to any doctor if you move, come to another hospital, have another event.
Similarly, having a record of your medications–which medicines you take, when you started them, what the dose is, and if for some reason you stop the medication, why did you stop it? “I stopped it two weeks after I started it because I got a big blotchy red rash,” or ”I stopped it two months afterwards because my doctor told me that my cholesterol levels had come down to the point where I no longer needed to be on it.”
That way, when you are seeing another doctor a year later and there’s a question about why did this happen or what happened, it’s easy to go back and refer to it. Basically it’s having patients do the same things that doctors do. None of us can be expected to remember the details of all these things as we are going through them or afterwards. We keep records, and if the patients keep records, that gives them a way of having some control on their own.
About Dr. Evans, M.D.:
Dr. Evans joined the Neurosciences faculty in July 2005. Dr. Evans received a BS in Chemistry, Magna Cum Laude, from the University of Southern California, and a MD from UCSD. After a year of Internal Medicine training at Loma Linda Medical Center, he returned to UCSD for his residency in neurology. He has received several awards for academic excellence during his training and was the 25th Anniversary Scholar for the UCSD School of Medicine. He was named the valedictorian of UCSD’s National Center of Leadership in Academic Medicine’s class of 2006. He is a full-time clinical neurologist at the UCSD Neuroscience Center at Alvarado Hospital Medical Center.