I’ve never received a thank-you note: A lupus patient's advice

Christine Miserandino has learned a thing or two from her frequent doctor's appointments for lupus. She writes about her illness on her web site, and says that before each appointment, she fills out three index cards: one with any new problems she needs to tell her doctor about, one describing her current symptoms, and a third with specific questions for the doctor.

She says this gets her better care. "My doctor is busy, and I have to respect that he has 40 patients in one day," she says. "If I don't go in with all my questions written down, I'd be rambling all over the place."

Doctors often schedule appointments in 15-minute increments. Sometimes you'll need much more than that. Christine says she always warns the appointment secretary when she'll need extra time, and asks whether a certain time of day (such as the last appointment) would be better.

Christine says she doesn't shy away from asking tough questions -- on the contrary, she asks lots of them and sometimes questions her doctor's recommendations -- but she always does it politely. Plus, she fosters a relationship with her doctor because she knows that to a great extent, her health depends on him.

"I do care, because I want him to care about me. I do bring cookies at Christmastime. It's a relationship you have to foster like any other."

Once, when her doctor went above and beyond what he had to do by visiting her in the hospital twice in one day, she wrote him a thank-you note. "He said to me, 'In the 20-odd years I've been doing this, I've never received a thank-you note. I always hear the negative, never the positive.'"

Browse for similar stories in our index at the very bottom of this page, or read a patient-physician miscommunication story.

Thanks to Elizabeth Cohen and Jennifer Pifer for the source story via CNN.

I never needed it in the first place: Unnecessary surgery - C section

When Barbara Stratton of Baltimore, Maryland, looks back at the birth of her son, Charlie, now 7, she’s angry — angry she had a surgery she believes she didn’t need. Babies delivered by C-section are at higher risk for complications, including breathing problems. Barbara said her obstetrician induced labor a week before her due date because she feared the baby would be too large to deliver if they waited for her to go into labor spontaneously. But even after being induced, her labor still didn’t progress, and she ended up with a Caesarean section. Her baby weighed 8 pounds, 7 ounces — far smaller than the obstetrician had predicted.

"I never needed the C-section in the first place," said Barbara.

The U.S. government and many obstetrical experts are working hard to reduce the number of women having C-sections. In 2004, 29% of babies in the U.S. were born by C-section, an increase of more than 40% since 1996. C-sections involve risks to the mother, including infections, bleeding, and pain. Babies born via C-sections have more breathing problems right after birth, according to the Office on Women's Health at the U.S. Department of Health and Human Services. Many experts think as many as half of all C-sections are unnecessary, the women’s health office said.

Barbara said that because of surgical complications she was in pain every day for a year and a half after her son was born. She became depressed.

"I was in pain every time I rolled over, every time I got out of bed, every time I got out of a chair," Barbara said. "It affected the quality of my mothering. I had trouble bonding with my son."

After her own disappointing birth experience, Barbara became a doula - a birth assistant who can advocate for a woman in labor.

Advice to pregnant women: Don’t get induced unless medically necessary. Studies of first-time moms show that 44% of those who are induced end up with a C-section but that only 8% of those who go into labor spontaneously end up with a C-section. Doctors say many times, inducing women way before the cervix is ready can lead to unproductive labor, which then necessitates a C-section.

Read a sextuplet story, or read Elizabeth Cohen’s source story.

Those were the shortest 15 minutes of my life: Stroke centers

Chuck Toeniskoetter says he's alive today because of a nurse and a paramedic who came to his aid when he collapsed one snowy day high atop a mountain.

They didn't administer CPR. They didn't give him life-saving drugs. They didn't treat him at all. What they did was get him to the right hospital.

The helicopter ambulance pilot wanted to take Chuck to the closest hospital. But the nurse and the paramedic suspected he'd had a stroke and urged the pilot to go to a certified stroke center, 15 minutes further away.

"They stood on the runners of the helicopter and were relentless with the pilot. They saved my life," he recalls.

At the stroke center in Roseville, California, Chuck received TPA, a drug that dissolved the clot in his brain. It's likely that at the other hospital -- the one the helicopter ambulance pilot wanted to take him to -- he wouldn't have received TPA.

After Chuck's experience, he started the Stroke Awareness Foundation, to help others choose the right hospital if they've had a stroke.

When he thinks about how the nurse and the paramedic argued for him to go the extra 15 minutes to the stroke center, he says he'll always be grateful.

"Those were the shortest 15 minutes of my life," he says.

Art Caplan’s Advice: The first step is to find out where an ambulance would take you if you dialed 911. If you want to go elsewhere, you might be out of luck. Often you can't persuade an ambulance driver to go to a stroke center if you've had a stroke, or to go to a children's hospital if your child is injured. But you can be an informed consumer and check with emergency service providers in your area to find which hospital you'd be taken to and see whether you'd be able to negotiate a different destination.

Read another of our stroke survivor stories, or read Elizabeth Cohen’s source story.