As we discussed many issues during the radio broadcast Friday January 27, 2012, this blog will be a bit scattered. I guess that is how medicine is though, as it encompasses many issues... in fact probably many more issues than you realize. If any of this bores you, please pass the info on to a friend, as I am certain that someone in your life can benefit from this knowledge if not yourself!
First, there is the issue of how realistic medical dramas are. Well, during medical school I was a St. Elsewhere addict, & so I am biased that it was a great show! To my recall, it was pretty realistic, showing the dilemmas of doctors in training. I recall my favorite episode in which one of the residents (a doctor in his specialty training) had lost his wife due to a head injury. His teacher, an older more experienced doctor was trying to offer some comfort, & told him a story. The elder doctor stated that when he was a young boy he had asked his father "why do people die," to which his father had replied, "that, son, is why you should become a physician." The teacher then commented, "I now know how people die, but I still don't know why." It was this sort of deep emotional drama that made me love that show, & I do believe it more fairly represented medicine than the newer shows. ER was of course very realistic in appearance as they were the first to use that special camera that allowed 360 degree filming of the actors as they moved about to save people in the ER. This did make you feel like you were right there, which was great if you like ER drama. But, all of medicine is not like that, & in fact I HATE the ER! To me it is nerve-racking. I prefer to keep people healthy so they can hopefully avoid the ER, & then I can too! Over time, ER became less realistic & that likely lead to its cancellation. Bring in House. Now, I must admit that I have only watched it once or twice, so it's probably not fair for me to judge, but I do know that if a doctor has an addiction problem, his is commanded to get treatment or his license to practice medicine is revoked. If he takes pain meds responsibly, I guess he might get away with it, but apparently that is not the case with Dr. House. Also, we live in a time when most doctors do not own hospitals, & as such we are all dispensable. If a doctor is guilty of misconduct, either with a patient, a nurse, another doctor, or a hospital administrator, he is reprimanded, & if the conduct continues he is "kicked off" staff. There are actually groups of our peers who review our work & our conduct (Peer Review Committees), & who thus have the right to remove our privileges at the hospital. A lot of what happens in these medical dramas is based on some fact, but of course it is hyped-up to sell the show. If you think you learn something medical on one of these shows, be sure to run it past your doctor to check it's accuracy! For me, some of the frustration of watching these shows lies in the fact that they often get some of their medical facts WRONG, as well as the fact that I do not lead the glorious life that they often portray. Contrary to popular representation on these shows, the hospital does not run amuck with personal affairs & sex does not happen in the closets!
Robert wanted to know about nursing degrees, & as I said, I have never been a nurse, so I am not the best to answer that question. I do know that there are levels of education in nursing, from LPN to RN, & within the RN there are "diploma" programs & "degree" programs. RN's can get a Bachelor's degree (BS), or they can go on to get a Master's or even a Doctorate (PhD). Many RN's are continuing their education & becoming ARNP's, which are nurses who function independent of doctors... they can run their own practices with some limitations, but basically serve as primary care "providers" much like myself. I would advise you to speak with someone in nursing to sort out the differences, but I do know that a profession in Nursing is definitely a good one! There is a shortage of nurses that is expected to worsen as our population ages, so it seems that there should be guaranteed employment in this field.
Skip asked about the difference between a doctor who has an MD vs. one with a DO. Again, I am an MD, so I am not that knowledgable about the DO program. I believe that we train similarly, with 4 years of medical education for each program. But I think the DO program has a 5th year of training as they learn not only what we learn, but additionally they learn manipulation much like a Chiropractor. I often wish I had that knowledge and expertise, as I think I would be more effective at evaluating & treating many of my patients' musculoskeletal problems! One must also realize that the doctor that one becomes is more based upon your Residency training than on your medical school training. That is to say that medical school is probably very similar program to program as this is basically learning medical literature & facts. On the other hand, residency training involves hands-on training, as well as the application of critical thinking. I trained at a hospital where there were only 2 residency programs, Family Practice & Ob-Gyn. As such, I feel I had great training as there were no Internal Medicine residents or ER residents or Surgery residents with whom to compete. I basically was the Internal Medicine resident when I did that "rotation," so I learned a lot! Every residency is unique, & in fact some DO doctors do their residency training in an MD program! Such is the case at Bayfront Medical Center where I trained with several DO's. Now that we are in private practice, I am certain that we practice very similarly despite our different medical school training. Again, I encourage anyone who is interested in becoming a physician to study hard & apply for MD & DO programs both. Go to which ever one accepts you, & become the best doctor you can, as ultimately the doctor you become is up to YOU! And by the way, medical school applicants do not all need to have degrees in science. The Admissions Committees for medical schools like diversity, & you can get into med school with a degree in Liberal Arts, Political Science, Landscape Architecture, or just about anything for which they give a Bachelor's degree. The Committees know that diversity in background leads to diversity in doctors, & this leads to new discoveries in the field of medicine. So do the science prerequisites, but study what you love, & apply! Also, if you don't get in the first time, try again... I got in after my second application, & I know people who got in after a third try!
Hemorrhoids... a literal pain in the ***! These are basically varicose veins in the anus or rectum. This means that they are veins that have become overstretched & thus hold too much blood. If you could see them, they look just like the varicose veins in one's legs. They can occur to people of all ages & don't care if you are male or female. They are the result of increased intra-abdominal pressure, so they often occur during pregnancy, or when someone does heavy lifting or straining. Thus if you do heavy lifting at work or during work-outs, you should wear a belt around your waist like those worn by Home Depot employees. This helps take the pressure off of your bottom side, & also helps lessen the chance of getting a hernia which is also due to too much intra-abdominal pressure. If you have constipation, this too can cause hemorrhoids, so try to keep your stools soft & don't strain to have a bowel movement! Be sure to take a stool-softener (like Colace), but avoid laxatives as they are addicting to the bowel & can lead to a need for more & more laxatives over time. There is one safe laxative which I freely recommend to my patients... Miralax. I guess that means "miracle laxative," as it is safe to take daily! It is Glycerin, which is a slippery substance, & as your body does not absorb it, it basically mixes with your food & helps it to slip through your intestines more easily. Note that it should be taken daily & not just when you are constipated... as that is a little late, based upon it's mode of action. Back to hemorrhoids... they can also form due to prolonged sitting, so lay down or get up... don't allow the pressure of your body to press down on your rectum too long! And certainly don't sit on the toilet too long, as this position allows for a lot of pooling of blood in your rectum/anus. If you must sit for a long time to have a bowel movement, sit on the toilet with the top DOWN so it supports your bottom side, & only open it when you are truly ready to have the BM! We all know that the symptoms of hemorrhoids involve pain or itching in the rectal area, as well as perhaps bleeding (usually with a BM, but sometimes even without) or a lump in the anus area. Be sure to have a doctor or other qualified medical professional take a look as sometimes rectal CANCER can have the same symptoms! Treatment involves changing your behavior regarding straining, & the over-the-counter meds, including things that numb (or anesthetise) such as Pramoxine which is found in Proctofoam, or vasoconstrictors (which shrink the tissue) such as Phenylephrine which is found in Preparation H. There are stronger forms of these meds which your doctor can prescribe, & often they include a steroid to shrink the tissue. I usually prescribe Proctofoam HC which includes Pramoxine (to numb) & a steroid (to shrink). Don't forget the good old-fashioned Sitz bath... just run some warm water in the bathtub & sit in it! This increased warmth increases circulation to the hemorrhoid & helps heal the tissue with healthy new blood. And if all else fails, or if you just don't want to deal with recurrences, consider surgical type options. This includes the Ultroid procedure mentioned by Scott. He called in to say he had this non-invasive in-office procedure with great results. Talk to your doctor or google to see options, though the Ultroid looks great as this procedure is done in an area of the rectum where there are no nerve endings, thus there should be NO PAIN! The websites indicate that insurance usually pays for this procedure & it only takes about 10-15 minutes to complete... makes me think it should be done sooner rather than later!
Irene wondered if taking Tylenol PM every night was bad for her. She uses it each night to help her sleep & is concerned about taking the Tylenol as she knows it is bad for her liver. Well, first we should understand that Tylenol PM is a drug which contains TWO drugs: Tylenol (=Acetaminophen) and Benadryl (=Diphenhydramine). Tylenol is a pain reliever, whereas Benadryl is an antihistamine which also causes sleepiness. If Irene takes Tylenol PM just to help her sleep, I would recommend that she get pure Benadryl, as she probably does not need the Tylenol component unless she has pain which interrupts her sleep. Remember, if you take over-the-counter meds, they too have side-effects. It is a good idea to discuss any meds or herbs that you take frequently with your doctor, just to be sure they are safe & to be sure the doctor is not concerned as to why you need that product often. Tylenol should not be taken in doses greater than 1,000 milligrams at once, & no more than 3-4,000 milligrams per day. They recently suggested that 3,000 mg per day should be the max, so I guess that has been down-graded. Regardless, remember that Tylenol is toxic to the liver, so even in low doses it can be dangerous if you have liver disease, if you drink a lot of alcohol, or if you take a lot of medications which are metabolized by your liver. Again, speak with your doctor or Pharmacist who can help you decide what is your safe dose!
And lastly, in honor of January which is National Blood Donor Awareness month, we thank those of you who can & do donate blood! America uses 44,000 units of blood per day to help those who have bled or who have anemia due to chronic illnesses, cancer treatment, surgery, etc. Only about 1/3 of the population is able to donate for one reason or another, so the other 2/3 of the population depends upon your generosity! So thank you!!! And if you want to donate, please contact your local Blood Bank to see if you are qualified to donate... & while you're there, see if you can register to be a bone marrow donor as well!
Here's to our health!
Gigi
Tune in Fridays for the Let's Talk Medical with Doctor Gigi radio show! We're on about 3:30-4:00PM Eastern time on WTAN 1340-AM or on www.SkipShow.com where you can listen live or to the PodCast version!
Sunday, January 29, 2012
Sunday, January 22, 2012
Migraine Headaches; Pediatric Tylenol; Medical Marijuana
Migraines affect many people, & those of us who have had one know how debilitating they can be! Some get them while they are young & some when they are older. Many women get "menstrual migraines," which occur monthly with their menstrual periods. Others, like myself, get them with menopausal changes. Some people get them due to food or alcohol. These headaches often have "warning signals" such as neck stiffness, food cravings, emotional changes, & irritability which can occur 1-2 days before the headache. Some people have an "aura" which occurs before the headache as well. These can be visual, such as seeing squiggly lines or flashes of light, but they can even be as frightening as stroke-like symptoms, including pins-&-needles sensations, difficulty with speech, & even weakness in an arm or leg. Once the headache strikes, it is generally on one side of the head, & the pain is usually throbbing or pulsating in nature. There is usually an increased sensitivity to light & sound, as well as nausea & vomitting. Some people feel light-headed or dizzy. These headaches often last 4 hours to 3 days if not treated, & once they resolve, the person still might feel exhausted for a day or two.
If you have a severe migraine, especially one with neurologic changes, you will want to see a physician to be sure it is not a stroke or brain mass, as your first episode will be frightening, even to your doctor! However, once you are diagnosed with migraine headaches, you can rest pretty comfortably in knowing that your migraine will usually follow a predictable pattern... that is to say that although we can describe migraines in many different ways, each person's pattern will be unique yet reproducible! So if you get neurologic symptoms followed by a severe headache, that is your unique pattern, & should not be frightening unless something changes!
Once you have established that you have migraines, you can try over-the-counter medications such as Excedrin Migraine to treat them. If this is not strong enough, you might want to get a prescription medicine such as Esgic Plus (which is similar to Fiorinal Plain), or perhaps Midrin. If this is not effective, the doctor can prescribe stronger medicine such as a "tryptan." These include Imitrex, Maxalt, Amerge, Axert, Relpax, Frova, & Zomig. These stronger medications have become the mainstay of treatment for migraines as they work so well, but they can be very expensive... consider trying Imitrex as it has a generic, so it should be cheaper! Also, there are various forms of these tryptans: some are pills to swallow, some are pills that melt in your mouth (good if you need to take a dose immediately & have nothing to drink), some are nose sprays, & some are even injected by the patient. If you have cardiovascular disease (such as chest pain from your heart, previous heart attack or bypasses, stroke or near-stroke called a TIA) you should probably avoid the tryptans as they do change blood flow in your body & can trigger chest pain, heart attack, or even stroke. Don't forget, some migraines respond well to Chiropractic treatment or Physical Therapy, so it is worthwhile to see one of these specialists for evaluation & treatment. I have had therapy with great results, & since I had cold laser treatment by Diane Hartley at Hartley PT, I have not had a full-blown migraine! Dr. Thorpe of Thorpe Chiropractic also does treatment for migraines, which likely involves treatment of the neck (cervical spine).
Now that we've discussed treatment of migraines, let's go backwards a bit to talk about prevention of migraines. First, if you can identify something that triggers the headaches, try your best to avoid it! If that doesn't work, you can always treat the headahces as above, but if you experience frequent or truly debilitating migraines, you should consider asking about something to prevent them. These options include several blood-pressure medicines: 1) Beta-blocker medicine such as Corgard, & 2) calcium-channel blockers such as Verapamil. These are very affordable, but they might both slow your heart rate (especially the Beta-blocker) & lower your blood pressure. The Verapamil might also constipate you & can cause your legs to swell. Your physician will be able to help decide if one or the other is appropriate for you. Elavil is another very affordable option to prevent migraines. It is an old tricyclic anti-depressant which works great, but which can cause constipation, sleepiness (so take it at night!), & weight gain. To treat depression you would have to take at least 150 milligrams per day, but you only need 10-30 milligrams for headache prevention. It also helps treat TMJ (temperomandibular joint dysfunction) & tension headache, both of which can somewhat mimick migraine! Lastly, Topamax is an anti-seizure medicine which also prevents migraine. It's downfall is the drowsiness it causes, thus it is sometimes called "dopamax." If you try it, start with a low dose & slowly increase it, as this helps you tolerate that side-effect. It is interesting to note that it causes weight loss, but desite this, very few people will take it long-term!
Obviously there is a lot to know about migraine, & a lot of choices when it comes to treatment &/or prevention. Be sure to pay attention to your pattern, & then discuss with your doctor to choose the best option for you. And remember, it might take several tries to find the best regiment for you!
Did you know that there was a change in the formulation of pediatric Tylenol? Apparently there was some confusion because there were different strenghts of the Tylenol liquid which lead to over or under-dosing of children. So Tylenol has been re-formulated to one standard concentration: 160 milligrams per 5 cc. Note that 5 cc are equal to 1 teaspoon, so there are 160 milligrams of Tylenol in 1 teaspoon of the new suspension. If you buy this strenghth, it can be used for newborns as young as 1 day old & 6 pounds to children 11 years old & 95 pounds. Of course, always speak with your physician before you give Tylenol to infants less than 3 months old, as these little guys often do not give us big hints that they are ill. Something as simple as a low-grade fever can be a sign of a very significant illness, & as such would warrant further evaluation INSTEAD of simply masking the illness by treating the one symptom (fever) with Tylenol!
Lastly, someone brought up the issue of marijuana being used to help with chronic pain. She indicated that she uses chronic narcotics for pain control, but when she had the opportunity to use marijuana, she was able to decrease the narcotic use. She noted that this is legal in New York state, though it is not in Florida. I am not aware of any legislation to legalize this in Florida, but I would love to see something other than narcotics available to help chronic pain patients! As you likely know, Florida is the number 1 state for narcotic abuse, so there is no denying the problem we have with narcotics! Though I have no proof of the safety of marijuana, I must say that I have no knowledge of a "pot-head" who murdered for his fix, much less one who "overdosed" & died getting his fix! I hope there is more research being done, & I hope this is NOT going to be another situation where politics block access to good medicine! Stay tuned, & stay involved!
Here's to our health!
Gigi
If you have a severe migraine, especially one with neurologic changes, you will want to see a physician to be sure it is not a stroke or brain mass, as your first episode will be frightening, even to your doctor! However, once you are diagnosed with migraine headaches, you can rest pretty comfortably in knowing that your migraine will usually follow a predictable pattern... that is to say that although we can describe migraines in many different ways, each person's pattern will be unique yet reproducible! So if you get neurologic symptoms followed by a severe headache, that is your unique pattern, & should not be frightening unless something changes!
Once you have established that you have migraines, you can try over-the-counter medications such as Excedrin Migraine to treat them. If this is not strong enough, you might want to get a prescription medicine such as Esgic Plus (which is similar to Fiorinal Plain), or perhaps Midrin. If this is not effective, the doctor can prescribe stronger medicine such as a "tryptan." These include Imitrex, Maxalt, Amerge, Axert, Relpax, Frova, & Zomig. These stronger medications have become the mainstay of treatment for migraines as they work so well, but they can be very expensive... consider trying Imitrex as it has a generic, so it should be cheaper! Also, there are various forms of these tryptans: some are pills to swallow, some are pills that melt in your mouth (good if you need to take a dose immediately & have nothing to drink), some are nose sprays, & some are even injected by the patient. If you have cardiovascular disease (such as chest pain from your heart, previous heart attack or bypasses, stroke or near-stroke called a TIA) you should probably avoid the tryptans as they do change blood flow in your body & can trigger chest pain, heart attack, or even stroke. Don't forget, some migraines respond well to Chiropractic treatment or Physical Therapy, so it is worthwhile to see one of these specialists for evaluation & treatment. I have had therapy with great results, & since I had cold laser treatment by Diane Hartley at Hartley PT, I have not had a full-blown migraine! Dr. Thorpe of Thorpe Chiropractic also does treatment for migraines, which likely involves treatment of the neck (cervical spine).
Now that we've discussed treatment of migraines, let's go backwards a bit to talk about prevention of migraines. First, if you can identify something that triggers the headaches, try your best to avoid it! If that doesn't work, you can always treat the headahces as above, but if you experience frequent or truly debilitating migraines, you should consider asking about something to prevent them. These options include several blood-pressure medicines: 1) Beta-blocker medicine such as Corgard, & 2) calcium-channel blockers such as Verapamil. These are very affordable, but they might both slow your heart rate (especially the Beta-blocker) & lower your blood pressure. The Verapamil might also constipate you & can cause your legs to swell. Your physician will be able to help decide if one or the other is appropriate for you. Elavil is another very affordable option to prevent migraines. It is an old tricyclic anti-depressant which works great, but which can cause constipation, sleepiness (so take it at night!), & weight gain. To treat depression you would have to take at least 150 milligrams per day, but you only need 10-30 milligrams for headache prevention. It also helps treat TMJ (temperomandibular joint dysfunction) & tension headache, both of which can somewhat mimick migraine! Lastly, Topamax is an anti-seizure medicine which also prevents migraine. It's downfall is the drowsiness it causes, thus it is sometimes called "dopamax." If you try it, start with a low dose & slowly increase it, as this helps you tolerate that side-effect. It is interesting to note that it causes weight loss, but desite this, very few people will take it long-term!
Obviously there is a lot to know about migraine, & a lot of choices when it comes to treatment &/or prevention. Be sure to pay attention to your pattern, & then discuss with your doctor to choose the best option for you. And remember, it might take several tries to find the best regiment for you!
Did you know that there was a change in the formulation of pediatric Tylenol? Apparently there was some confusion because there were different strenghts of the Tylenol liquid which lead to over or under-dosing of children. So Tylenol has been re-formulated to one standard concentration: 160 milligrams per 5 cc. Note that 5 cc are equal to 1 teaspoon, so there are 160 milligrams of Tylenol in 1 teaspoon of the new suspension. If you buy this strenghth, it can be used for newborns as young as 1 day old & 6 pounds to children 11 years old & 95 pounds. Of course, always speak with your physician before you give Tylenol to infants less than 3 months old, as these little guys often do not give us big hints that they are ill. Something as simple as a low-grade fever can be a sign of a very significant illness, & as such would warrant further evaluation INSTEAD of simply masking the illness by treating the one symptom (fever) with Tylenol!
Lastly, someone brought up the issue of marijuana being used to help with chronic pain. She indicated that she uses chronic narcotics for pain control, but when she had the opportunity to use marijuana, she was able to decrease the narcotic use. She noted that this is legal in New York state, though it is not in Florida. I am not aware of any legislation to legalize this in Florida, but I would love to see something other than narcotics available to help chronic pain patients! As you likely know, Florida is the number 1 state for narcotic abuse, so there is no denying the problem we have with narcotics! Though I have no proof of the safety of marijuana, I must say that I have no knowledge of a "pot-head" who murdered for his fix, much less one who "overdosed" & died getting his fix! I hope there is more research being done, & I hope this is NOT going to be another situation where politics block access to good medicine! Stay tuned, & stay involved!
Here's to our health!
Gigi
Monday, January 16, 2012
How to be Prepared as a Patient, More Medical-Legal Issues, & Menopausal Hormone Replacement
Topics discussed on the January 13, 2012 radio show included some hints to help prepare people to be better patients, some more issues illustrating how legal matters affect medical care, as well as some thoughts regarding hormone replacement for menopausal women.
First, one must always remember that YOU, the patient, are the best source of medical data, & as such, you should document that information for future use. If you have access to a computer gadget you can find an "app" to help you organize & record that information. I have an iPod & have found a very useful app called "My Medical," which is a free app which I use to organize my personal medical information. It allows you to input personal information such as your name, address, & date of birth. It then guides you to input your personal medical information such as blood type (if you know it), medical illnesses, past surgeries, allergies, medications/doses, & your physicians' names & numbers. You can also enter the dates of your last mammogram, colonoscopy, immunizations, etc. Once you input the data, you can print it out for doctor visits, & in case of an emergency, the data is available to appropriate medical personel. Be sure to keep the data current... & to do so, consider reviewing it BEFORE appointments or surgeries, as well as afterwards! Though there is a move toward a single computerized medical record, the system is not perfect & YOU are still the best source of information regarding your medical history... IF you apply yourself & keep it up to date! And don't forget, a pen & paper work very well if you are not thrilled with computers!
Also, though a single computerized record (or national data base) of all your medical information sounds like a great advancement in medical care, we discussed issues related to problems that occur when the data recorded is wrong. Often diagnoses are based on a doctor's best guess, so they are not always "proven." Such is the case whereby a person presents to his physician with complaints of sadness, fatigue, & weight gain. Many physicians would empirically (by educated guesswork) diagnose "depression." However, if the patient failed to respond appropriately to treatment for depression, the doctor might then order lab tests to see if there is another cause for the depressive symptoms. In this case he might find that the patient has hypothyroidism (a slow thyroid) which can make a person look & feel depressed. Stopping the anti-depressant medication & starting appropriate therapy with Synthroid (or a similar thyroid supplement) will correct the patient's problem, but the computerized record might continue to indicate that the patient has/had "depression" when in fact that is an incorrect diagnosis! Also, unlike a paper source which allows a doctor or nurse to correct inaccurate data with an obvious single scratch-through line, the computer record requires an ADDENDUM be placed at the end of the note indicating the change... and these are easily overlooked! It is also much easier to make data entry errors when typing as opposed to handwritten data capture. I recently saw an Emergency Room report which indicated that my 60 year old patient was not a drinker nor a smoker, but it said she was a drug-abuser, which she was not! Obviously someone hit the "yes" button instead of the "no" button! When I saw this in her record I asked her to go to that hospital to have the information corrected... & I think it took her 3 different attempts to have them complete that task... but again, they would only write it as an addendum, so unless the record is scrutinized, she is a drug-abuser! We also made comments regarding misdiagnoses, such as a person who was in a car accident (not as the driver) after attending a party. As the non-designated driver, he had had a few drinks, & his alcohol level was consistent with being drunk. The ER doctor incorrectly "diagnosed" him as "alcoholic," though I learned that an alcoholic is someone who continues to drink in spite of negative consequences. This person was in an accident, though it was not his fault, as he was not driving. And though he was drunk, he was not breaking any law. As to whether alcohol was negatively impacting his life, I doubt the ER doctor spent enough time with him to gather that knowledge. So in short, I think this was a misdiagnosis, but unfortunately he will probably never get that off of his record!
On to other ramblings... it is NOT necessary to know your blood type, unless you are simply curious! When or if you donate blood, they will be able to tell you your blood type. Also, the Blood Bank does many compatibility tests, not just the ABO & Rh factors which most of us know. In other words, even if you have the same blood type as someony else, you might not be able to donate blood directly to her, as there are many (not just 2) factors that must match. If you are trying to donate for someone who is ill, the Blood Bank will gladly take your blood, though your friend or family member might not receive that blood. Instead, they will give it to the person whom it matches best, & your friend or family member will receive "credit" for the donation. Others who donate will hopefully match your friend or family member, so we encourage all healthy people to consider donating blood as this gives us more likelihood of finding a good match for everyone! And remember, the Blood Bank is very strict in regards to who is allowed to donate. This is what is necessary to provide SAFE blood for all of us. So if you are healthy & take few medications, consider giving blood. You never know who you might help with your generosity! And don't forget to ask them how you can also be evaluated to be a bone marrow donor, as I understand it just takes a small sample of your blood (not a bone marrow sample!).
The topic of death certificates came up as an example of medical & legal intertwinings. Did you know that your primary care doctor is charged by the law with completing your death certificate? Only if the Medical Examiner feels your death warrants further investigation will you have an autopsy. This means that your primary care physician can ASK for an autopsy, but the Medical Examiner can refuse, & in this instance your primary care doctor MUST complete the death certificate within 2 days of your death. I had this happen years ago when a 60'ish year old patient (& friend) died suddenly. The ME did not feel an autopsy was necessary as the patient was older than 50 years, & as she had cardiovascular risks. I argued that there was no history of cardiac symptoms, & requested that an autopsy be performed as I was not able to determine her cause of death. I was told by the ME that if I did not complete the death certificate, I would be in breech of the law. I still refused, which got me a phone call from Tallahassee... the Dept. of Vital Statistics. They informed me that "the Death Certificate is NOT a legal document" & as such cannot be used in a court of law. Thus it is acceptable to guess as to the cause of death! They further informed me that if the "family" wanted an autopsy, they could pay for a private one, but I still MUST fill out the Death Certificate as that is the law! I later got a copy of the law from my malpractice attorney. It indicated that the Medical Examiner shall conduct an autopsy "when the patient dies suddenly while in apparent good health." I wrote to the group that oversees the Medical Examiners in the state of Florida, & I asked them whether that is determined by the primary care doctor who knows the patient or by the ME who does not. Their reply in writing was: "We don't have to answer that question." I don't know about you, but that seems like a bureaucratic answer to a simple appropriate medical question!
In cases where the person has a life-insurance policy, the cause of death might affect the pay-out. In these circumstances, if the family disagrees with the Medical Examiner or primary care doctor's assessment of the cause of death, they must pay to have a private autopy performed to truly determine the cause of death. However, sometimes it is better not to know the truth, as was the case with one 40'ish year old patient who "drowned." The Medical Examiner determined that it was an accidental death by drowning, but the wife believed he had suffered a heart attack. She requested a private autopsy, but after reviewing his life insurance policy, she cancelled the request. The policy would provide a benefit of $100,000 upon her husband's death, BUT it would provide $200,000 if the death was accidental. Since the ME felt it was accidental, she & her family would easily recieve the higher benefits... as long as there was no evidence to the contrary!
Lastly, we briefly discussed menopausal hormone replacement, & why men might care in the long-run. Menopause is in essence an absence of ovarian function... either they stop working or they are surgically removed. Without the ovaries, women do not produce estrogen, progesterone, & testosterone. This causes many changes in women, such as hot flashes, mood swings, & poor sleep. Not all women suffer severely, but thin women generally have more symptoms, as heavier women have fat cells which produce some estrogen. The choice as to whether a lady takes hormones after menopause is a personal decision which is based upon her medical history, family history, degree of symptomatology, & personal preferences. In general, a woman with a history of blood clots (in the lungs or in the legs), or one who has had a stroke or heart attack is not a good candidate for hormone replacement, nor is a woman with a personal history or family history of breast cancer. It is best to discuss these issues with your Primary Care doctor &/or your Ob-Gyn, & then make your choice. There are pills, patches, & creams that will deliver these hormones, & that choice is also one of personal preference as pills are generally cheaper, but patches & creams are probably safer. The idea of "bio-identical" hormones is envogue, but they will never be identical to what you had before menopause UNLESS you measure those levels in your youth, as everyone has different levels of estrogen, progesterone, & testosterone based upon genetics. On the other hand, "bio-identical" hormones might also indicate that they replace what the body makes... in other words, estrogen, progesterone, AND testosterone, as until recently physicians only replaced estrogen & progesterone. In the long run, though it is the woman's choice, it will affect her partner, as one of the other side-effects of menopause is "atrophic vaginitis." This is a condition which is caused by a lack of estrogen which results in the vaginal tissues being dry. Often the dryness & loss of elasticity leads to pain with intercourse, thus affecting our intimate relationships as well!
Again, here's to our health!
Gigi
PS Don't forget the radio broadcasts on Fridays or on Podcasts... www.skipshow.com.
First, one must always remember that YOU, the patient, are the best source of medical data, & as such, you should document that information for future use. If you have access to a computer gadget you can find an "app" to help you organize & record that information. I have an iPod & have found a very useful app called "My Medical," which is a free app which I use to organize my personal medical information. It allows you to input personal information such as your name, address, & date of birth. It then guides you to input your personal medical information such as blood type (if you know it), medical illnesses, past surgeries, allergies, medications/doses, & your physicians' names & numbers. You can also enter the dates of your last mammogram, colonoscopy, immunizations, etc. Once you input the data, you can print it out for doctor visits, & in case of an emergency, the data is available to appropriate medical personel. Be sure to keep the data current... & to do so, consider reviewing it BEFORE appointments or surgeries, as well as afterwards! Though there is a move toward a single computerized medical record, the system is not perfect & YOU are still the best source of information regarding your medical history... IF you apply yourself & keep it up to date! And don't forget, a pen & paper work very well if you are not thrilled with computers!
Also, though a single computerized record (or national data base) of all your medical information sounds like a great advancement in medical care, we discussed issues related to problems that occur when the data recorded is wrong. Often diagnoses are based on a doctor's best guess, so they are not always "proven." Such is the case whereby a person presents to his physician with complaints of sadness, fatigue, & weight gain. Many physicians would empirically (by educated guesswork) diagnose "depression." However, if the patient failed to respond appropriately to treatment for depression, the doctor might then order lab tests to see if there is another cause for the depressive symptoms. In this case he might find that the patient has hypothyroidism (a slow thyroid) which can make a person look & feel depressed. Stopping the anti-depressant medication & starting appropriate therapy with Synthroid (or a similar thyroid supplement) will correct the patient's problem, but the computerized record might continue to indicate that the patient has/had "depression" when in fact that is an incorrect diagnosis! Also, unlike a paper source which allows a doctor or nurse to correct inaccurate data with an obvious single scratch-through line, the computer record requires an ADDENDUM be placed at the end of the note indicating the change... and these are easily overlooked! It is also much easier to make data entry errors when typing as opposed to handwritten data capture. I recently saw an Emergency Room report which indicated that my 60 year old patient was not a drinker nor a smoker, but it said she was a drug-abuser, which she was not! Obviously someone hit the "yes" button instead of the "no" button! When I saw this in her record I asked her to go to that hospital to have the information corrected... & I think it took her 3 different attempts to have them complete that task... but again, they would only write it as an addendum, so unless the record is scrutinized, she is a drug-abuser! We also made comments regarding misdiagnoses, such as a person who was in a car accident (not as the driver) after attending a party. As the non-designated driver, he had had a few drinks, & his alcohol level was consistent with being drunk. The ER doctor incorrectly "diagnosed" him as "alcoholic," though I learned that an alcoholic is someone who continues to drink in spite of negative consequences. This person was in an accident, though it was not his fault, as he was not driving. And though he was drunk, he was not breaking any law. As to whether alcohol was negatively impacting his life, I doubt the ER doctor spent enough time with him to gather that knowledge. So in short, I think this was a misdiagnosis, but unfortunately he will probably never get that off of his record!
On to other ramblings... it is NOT necessary to know your blood type, unless you are simply curious! When or if you donate blood, they will be able to tell you your blood type. Also, the Blood Bank does many compatibility tests, not just the ABO & Rh factors which most of us know. In other words, even if you have the same blood type as someony else, you might not be able to donate blood directly to her, as there are many (not just 2) factors that must match. If you are trying to donate for someone who is ill, the Blood Bank will gladly take your blood, though your friend or family member might not receive that blood. Instead, they will give it to the person whom it matches best, & your friend or family member will receive "credit" for the donation. Others who donate will hopefully match your friend or family member, so we encourage all healthy people to consider donating blood as this gives us more likelihood of finding a good match for everyone! And remember, the Blood Bank is very strict in regards to who is allowed to donate. This is what is necessary to provide SAFE blood for all of us. So if you are healthy & take few medications, consider giving blood. You never know who you might help with your generosity! And don't forget to ask them how you can also be evaluated to be a bone marrow donor, as I understand it just takes a small sample of your blood (not a bone marrow sample!).
The topic of death certificates came up as an example of medical & legal intertwinings. Did you know that your primary care doctor is charged by the law with completing your death certificate? Only if the Medical Examiner feels your death warrants further investigation will you have an autopsy. This means that your primary care physician can ASK for an autopsy, but the Medical Examiner can refuse, & in this instance your primary care doctor MUST complete the death certificate within 2 days of your death. I had this happen years ago when a 60'ish year old patient (& friend) died suddenly. The ME did not feel an autopsy was necessary as the patient was older than 50 years, & as she had cardiovascular risks. I argued that there was no history of cardiac symptoms, & requested that an autopsy be performed as I was not able to determine her cause of death. I was told by the ME that if I did not complete the death certificate, I would be in breech of the law. I still refused, which got me a phone call from Tallahassee... the Dept. of Vital Statistics. They informed me that "the Death Certificate is NOT a legal document" & as such cannot be used in a court of law. Thus it is acceptable to guess as to the cause of death! They further informed me that if the "family" wanted an autopsy, they could pay for a private one, but I still MUST fill out the Death Certificate as that is the law! I later got a copy of the law from my malpractice attorney. It indicated that the Medical Examiner shall conduct an autopsy "when the patient dies suddenly while in apparent good health." I wrote to the group that oversees the Medical Examiners in the state of Florida, & I asked them whether that is determined by the primary care doctor who knows the patient or by the ME who does not. Their reply in writing was: "We don't have to answer that question." I don't know about you, but that seems like a bureaucratic answer to a simple appropriate medical question!
In cases where the person has a life-insurance policy, the cause of death might affect the pay-out. In these circumstances, if the family disagrees with the Medical Examiner or primary care doctor's assessment of the cause of death, they must pay to have a private autopy performed to truly determine the cause of death. However, sometimes it is better not to know the truth, as was the case with one 40'ish year old patient who "drowned." The Medical Examiner determined that it was an accidental death by drowning, but the wife believed he had suffered a heart attack. She requested a private autopsy, but after reviewing his life insurance policy, she cancelled the request. The policy would provide a benefit of $100,000 upon her husband's death, BUT it would provide $200,000 if the death was accidental. Since the ME felt it was accidental, she & her family would easily recieve the higher benefits... as long as there was no evidence to the contrary!
Lastly, we briefly discussed menopausal hormone replacement, & why men might care in the long-run. Menopause is in essence an absence of ovarian function... either they stop working or they are surgically removed. Without the ovaries, women do not produce estrogen, progesterone, & testosterone. This causes many changes in women, such as hot flashes, mood swings, & poor sleep. Not all women suffer severely, but thin women generally have more symptoms, as heavier women have fat cells which produce some estrogen. The choice as to whether a lady takes hormones after menopause is a personal decision which is based upon her medical history, family history, degree of symptomatology, & personal preferences. In general, a woman with a history of blood clots (in the lungs or in the legs), or one who has had a stroke or heart attack is not a good candidate for hormone replacement, nor is a woman with a personal history or family history of breast cancer. It is best to discuss these issues with your Primary Care doctor &/or your Ob-Gyn, & then make your choice. There are pills, patches, & creams that will deliver these hormones, & that choice is also one of personal preference as pills are generally cheaper, but patches & creams are probably safer. The idea of "bio-identical" hormones is envogue, but they will never be identical to what you had before menopause UNLESS you measure those levels in your youth, as everyone has different levels of estrogen, progesterone, & testosterone based upon genetics. On the other hand, "bio-identical" hormones might also indicate that they replace what the body makes... in other words, estrogen, progesterone, AND testosterone, as until recently physicians only replaced estrogen & progesterone. In the long run, though it is the woman's choice, it will affect her partner, as one of the other side-effects of menopause is "atrophic vaginitis." This is a condition which is caused by a lack of estrogen which results in the vaginal tissues being dry. Often the dryness & loss of elasticity leads to pain with intercourse, thus affecting our intimate relationships as well!
Again, here's to our health!
Gigi
PS Don't forget the radio broadcasts on Fridays or on Podcasts... www.skipshow.com.
Sunday, January 8, 2012
Legal issues that affect your medical care.
If you listened to Let's Talk Medical with Doctor Gigi on Friday Jan. 6, 2012, you have heard the following issues as Skip & I discussed them live. This blog will simply put that conversation in print & give me a second opportunity to "think" before I speak!
We spoke about a 60 year old man who presented to a Walk-in Clinic with complaints of leg pain after falling off of a ladder. The clinic did an x-ray of the injured leg & diagnosed an acute fracture. The patient was given a splint & was told to see an Orthopedic doctor... which would be delayed by at least 3 days due to the New Year holiday. The patient's wife later called me (as I was "on call" for the patient's primary care doctor) to ask for help, as the Tylenol & Advil were just not controlling his pain. When I asked why the Walk-in Clinic had not provided a narcotic pain prescription, the wife replied that they had a big sign posted indicating that they "do NOT give narcotic medicines." Needless to say, I think that the care rendered by the physician was less than complete, as I suspect that if he/she had a broken leg, he/she would have demanded to have appropriate pain management! I did help the patient, but many physicians would not have, as we are fearful of losing our licenses to practice medicine if anyone questions that we are over-prescribing narcotics... which are horrendously abused throughout the US, but especially in Florida (where I practice). I am certain that the posted disclaimer is to dissuade drug-abusers from going to the Walk-in Clinic to get refills of narcotics "after-hours," but apparently it has also hampered others from getting much needed appropriate care!
We also discussed that I had to meet a patient in person to hand him a handwritten prescription to refill Ritalin. Ritalin is basically "speed" which is prescribed for ADD (Attention Deficit Disorder), & in these people it acts "backwards" to slow them down & allow them to focus appropriately on tasks such as work & study. Again, I see the great potential for abuse, but based upon the Pharmacist's records, he was not an abuser & was appropriately due for a refill. Again, I did the right thing & went out of my way to get the prescription to him, but as per the law, I could not phone it in & thus had to actually meet him to hand it off. I don't know about you, but I feel this is over-involvement of the government which burdens me & makes it difficult for patients with this disease to get appropriate care. It seems to me that I have the knowledge & the responsibility to practice medicine, but unfortunately I am losing the RIGHT to do so freely & in the best interest of my patient!
The point of all this is to make you realize that when you hear news regarding new laws that affect healthcare, remember that those laws might have negative impact on your care! I am not a lawyer, so I find it difficult to practice medicine when medicine itself has become a business heavily regulated by legal constraints. Have you noticed that when you are in a car accident most of you end up seeing a lawyer who then refers you to a doctor with whom he works? That is because many physicians refuse to see cases which will wind up in court, as we feel unprepared to negotiate the legal system in a manner that will help our patients. To this end, there are physicians who work in that arena all the time... yet these are not your usual primary care doctors... you know, the one's who know you best & can probably care the best for you!
We also discussed that sometimes a dying patient's wishes are not followed, as doing so might result in a lawsuit against the doctor or hospital. Let's say the patient wants to be a "no code"... indicating that he refuses heroics to just keep him alive if there is no hope for meaningful recovery... but a family member shows up & wants all heroics. As I say, the patient will not sue me if he is vegetative, but the family member might sue if I "let the patient die." Since I don't have time or money to deal with this legal dilemma, I am likely to do what the family requests though I know it is terribly wrong & definitely in oppostion of the doctor-patient relationship!!! The moral of this story is to make sure that your medical & legal paperwork is in order, AND make sure that you discuss this with your family to ensure they follow YOUR wishes and not their own!
It is worth mentioning that if you want a physician to care for you, it is best to establish with that doctor on a "good" day so the doctor has a baseline as to what "normal" is for you. Thus when you are ill, he will be better able to judge the severity of that illness & provide the best plan of care for YOU... the individual that you are! In other words, a cough is less significant in a young healthy non-smoker than in an elderly smoker who uses breathing medicines on a normal day.
One e-mail which I received brought up the subject of getting free medicine from the pharmaceutical companies. This is through a program called the Patient Assistance Program. If you cannot afford a medicine that your doctor prescribed, first ask if there is a generic (not name-brand) medicine that will suffice, as these are much more affordable on the average. If this is not an option, Google the medicine name & find the manufacturer. Go to the manufacturer's website & see if they have a Patient Assistance Program, & if they do, print the application. You will need to complete some information regarding your income & your diagnosis, & perhaps your physician will have to fill out a part as well. After mailing the completed application to the manufacturer, they will review it, & if you qualify for assistance, they will mail the medicine to your doctor who will notify you to pick it up.
There was a question regarding how safe our blood supply is in regards to HIV. You see, when a person first contracts HIV, he will feel as though he has the flu. With such general symptoms, it is not likely that he will see a doctor, & even if he does, he is not likely to be diagnosed with HIV. This acute illness lasts for several weeks, & during this time, the patient will be HIV negative as his body has not yet responded to the HIV virus by making an "antibody." Unfortunately our HIV tests look for the antibody rather than the virus itself, so there are several weeks between acute HIV infection & our ability to diagnose HIV. Thus a person could conceivably donate blood which is acutely infected with HIV virus but not yet HIV positive... so the Blood Bank would take that blood & give it to an ill person not realizing how infectious it is! Obviously our teaching point here is that receiving a blood transfusion is a little risky, & it is always best to receive blood from a family member who you know & trust! But in the absence of a well-known donor, we can only hope that the Blood Bank continues it's rigorous questioning of donors, as it is the donor's history of illness, travel, medications, etc. which help them to determine whether or not they will allow that person to donate blood.
Lastly, I promised to put in print information regarding 2 exciting programs to help women with breast health. These are 2 programs for low-income, non-insured women in Pinellas County. They are:
1. The Mammography Voucher Program - for women 40 - 49 years old.
For information & eligibility requirements, call: (727)-820-4117.
2. Florida Breast & Cervical Cancer Early Detection Program - for women 50 - 64 years old.
For information & eligibility requirements, call: (727)-824-6917.
Remember that these programs will assist you to get a mammogram if you qualify, AND they will provide further assistance with follow-up studies such as Ultrasound or even biopsy. They will even help with treatment for breast cancer such as surgery & chemotherapy! BUT you must start the process with them... meaning that if you get the mammogram from the program, they will provide further necessary care! DO NOT get the mammogram elsewhere FIRST, as they will not help you once that has been done! And remember, these programs are for full-time residents of Pinellas County. If you live in a different county, parish, or even state, ask your local Health Department if they have similar programs.
Until next time, stay healthy & check out my live radio show Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Petersburg area Fridays from 3:30-4:00PM Eastern time, or on www.skipshow.com, where you can listen live OR you can listen to the recorded version via Podcast. And don't forget, you can call in with questions during the live show via: (727)-441-3000 or tollfree via: (866)-TAN-1340. If you prefer, you can e-mail me at: DrGigi@skipshow.com.
Here's to our health!
Gigi
We spoke about a 60 year old man who presented to a Walk-in Clinic with complaints of leg pain after falling off of a ladder. The clinic did an x-ray of the injured leg & diagnosed an acute fracture. The patient was given a splint & was told to see an Orthopedic doctor... which would be delayed by at least 3 days due to the New Year holiday. The patient's wife later called me (as I was "on call" for the patient's primary care doctor) to ask for help, as the Tylenol & Advil were just not controlling his pain. When I asked why the Walk-in Clinic had not provided a narcotic pain prescription, the wife replied that they had a big sign posted indicating that they "do NOT give narcotic medicines." Needless to say, I think that the care rendered by the physician was less than complete, as I suspect that if he/she had a broken leg, he/she would have demanded to have appropriate pain management! I did help the patient, but many physicians would not have, as we are fearful of losing our licenses to practice medicine if anyone questions that we are over-prescribing narcotics... which are horrendously abused throughout the US, but especially in Florida (where I practice). I am certain that the posted disclaimer is to dissuade drug-abusers from going to the Walk-in Clinic to get refills of narcotics "after-hours," but apparently it has also hampered others from getting much needed appropriate care!
We also discussed that I had to meet a patient in person to hand him a handwritten prescription to refill Ritalin. Ritalin is basically "speed" which is prescribed for ADD (Attention Deficit Disorder), & in these people it acts "backwards" to slow them down & allow them to focus appropriately on tasks such as work & study. Again, I see the great potential for abuse, but based upon the Pharmacist's records, he was not an abuser & was appropriately due for a refill. Again, I did the right thing & went out of my way to get the prescription to him, but as per the law, I could not phone it in & thus had to actually meet him to hand it off. I don't know about you, but I feel this is over-involvement of the government which burdens me & makes it difficult for patients with this disease to get appropriate care. It seems to me that I have the knowledge & the responsibility to practice medicine, but unfortunately I am losing the RIGHT to do so freely & in the best interest of my patient!
The point of all this is to make you realize that when you hear news regarding new laws that affect healthcare, remember that those laws might have negative impact on your care! I am not a lawyer, so I find it difficult to practice medicine when medicine itself has become a business heavily regulated by legal constraints. Have you noticed that when you are in a car accident most of you end up seeing a lawyer who then refers you to a doctor with whom he works? That is because many physicians refuse to see cases which will wind up in court, as we feel unprepared to negotiate the legal system in a manner that will help our patients. To this end, there are physicians who work in that arena all the time... yet these are not your usual primary care doctors... you know, the one's who know you best & can probably care the best for you!
We also discussed that sometimes a dying patient's wishes are not followed, as doing so might result in a lawsuit against the doctor or hospital. Let's say the patient wants to be a "no code"... indicating that he refuses heroics to just keep him alive if there is no hope for meaningful recovery... but a family member shows up & wants all heroics. As I say, the patient will not sue me if he is vegetative, but the family member might sue if I "let the patient die." Since I don't have time or money to deal with this legal dilemma, I am likely to do what the family requests though I know it is terribly wrong & definitely in oppostion of the doctor-patient relationship!!! The moral of this story is to make sure that your medical & legal paperwork is in order, AND make sure that you discuss this with your family to ensure they follow YOUR wishes and not their own!
It is worth mentioning that if you want a physician to care for you, it is best to establish with that doctor on a "good" day so the doctor has a baseline as to what "normal" is for you. Thus when you are ill, he will be better able to judge the severity of that illness & provide the best plan of care for YOU... the individual that you are! In other words, a cough is less significant in a young healthy non-smoker than in an elderly smoker who uses breathing medicines on a normal day.
One e-mail which I received brought up the subject of getting free medicine from the pharmaceutical companies. This is through a program called the Patient Assistance Program. If you cannot afford a medicine that your doctor prescribed, first ask if there is a generic (not name-brand) medicine that will suffice, as these are much more affordable on the average. If this is not an option, Google the medicine name & find the manufacturer. Go to the manufacturer's website & see if they have a Patient Assistance Program, & if they do, print the application. You will need to complete some information regarding your income & your diagnosis, & perhaps your physician will have to fill out a part as well. After mailing the completed application to the manufacturer, they will review it, & if you qualify for assistance, they will mail the medicine to your doctor who will notify you to pick it up.
There was a question regarding how safe our blood supply is in regards to HIV. You see, when a person first contracts HIV, he will feel as though he has the flu. With such general symptoms, it is not likely that he will see a doctor, & even if he does, he is not likely to be diagnosed with HIV. This acute illness lasts for several weeks, & during this time, the patient will be HIV negative as his body has not yet responded to the HIV virus by making an "antibody." Unfortunately our HIV tests look for the antibody rather than the virus itself, so there are several weeks between acute HIV infection & our ability to diagnose HIV. Thus a person could conceivably donate blood which is acutely infected with HIV virus but not yet HIV positive... so the Blood Bank would take that blood & give it to an ill person not realizing how infectious it is! Obviously our teaching point here is that receiving a blood transfusion is a little risky, & it is always best to receive blood from a family member who you know & trust! But in the absence of a well-known donor, we can only hope that the Blood Bank continues it's rigorous questioning of donors, as it is the donor's history of illness, travel, medications, etc. which help them to determine whether or not they will allow that person to donate blood.
Lastly, I promised to put in print information regarding 2 exciting programs to help women with breast health. These are 2 programs for low-income, non-insured women in Pinellas County. They are:
1. The Mammography Voucher Program - for women 40 - 49 years old.
For information & eligibility requirements, call: (727)-820-4117.
2. Florida Breast & Cervical Cancer Early Detection Program - for women 50 - 64 years old.
For information & eligibility requirements, call: (727)-824-6917.
Remember that these programs will assist you to get a mammogram if you qualify, AND they will provide further assistance with follow-up studies such as Ultrasound or even biopsy. They will even help with treatment for breast cancer such as surgery & chemotherapy! BUT you must start the process with them... meaning that if you get the mammogram from the program, they will provide further necessary care! DO NOT get the mammogram elsewhere FIRST, as they will not help you once that has been done! And remember, these programs are for full-time residents of Pinellas County. If you live in a different county, parish, or even state, ask your local Health Department if they have similar programs.
Until next time, stay healthy & check out my live radio show Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Petersburg area Fridays from 3:30-4:00PM Eastern time, or on www.skipshow.com, where you can listen live OR you can listen to the recorded version via Podcast. And don't forget, you can call in with questions during the live show via: (727)-441-3000 or tollfree via: (866)-TAN-1340. If you prefer, you can e-mail me at: DrGigi@skipshow.com.
Here's to our health!
Gigi
Wednesday, January 4, 2012
Here's to a Happy New Year & a new endeavor!
So 2012 has arrived! Despite predictions that it will be our last year on Earth (the Mayan calendar reportedly ends on 12/21/12!), I hope to pursue a goal of educating friends, family, & other followers in matters of health. I am a Family Physician who has practiced in St. Petersburg, FL since 1990. I currently run a solo Family Practice office & conduct clinical research as well. I attempt to provide full service medical care to my patients & their families. I see patients in the office, care for them in the hospital, & assist during their surgical procedures. Though I "survived" a 3 year residency in Family Practice (now renamed Family Medicine), I no longer practice the full scope of medicine for which I was trained... for many reasons... most of which have to do with legal issues, reimbursement issues, time constraints, etc. I have found myself extremely frustrated by our present medical environment, & I fear that the incredible medical industry which was built up from the 1960's to the 1990's, has been in a downhill spiral since the late 1990's. I worry that in a world where we have the most medical knowledge, we lack the ability to appropriately communicate & deliver high-quality medical care! I see a lack of understanding of basic scientific principles, & a lack of critical thinking, as well as a lack of true "caring" from our "caring professionals." I see an ever growing dependence on "cookbook" medicine & clinical pathways which attempt to treat patients as diagnoses rather than as individuals! I have witnessed the shift from the 1990's when primary care physicians such as myself provided a "medical home" for the patient... caring for him in the out-patient, as well as in the in-patient (hospital) setting, to the present time when many primary care physicians no longer provide hospital care. As you may know, there is now a push to get patients "in & out" of the hospital as quickly as possible, thus the industry has created a new specialist... the Hospitalist... who only cares for hospitalized patients, & thus has no other appointments or phone calls to distract from doing that job as quickly as possible. The problem is that this significantly fragments the patient's care, as there is no longer a primary care physician who has full knowledge of & involvement with all aspects of that patient's medical care.
Because of these concerns & frustrations, I have sought ways that I might educate people to be better at navigating the health care system, & thus to become better consumers of health care. To that end I have been broadcasting a radio talk show: Let's Talk Medical with Doctor Gigi. The show airs on Fridays on WTAN 1340-AM from 3:30-4:00PM in the St. Petersburg/Tampa area. Computer access to live broadcasts, as well as to the recorded podcasts, is available via www.skipshow.com. The format of the show is education in regards to medical issues. This involves any & all aspects of medicine, including preventive care, diseases, immunizations, economics, insurance, & politics... to name but a few! I do not propose to be an "expert" in any of these arenas, but 21 years of active practice have certainly given me an abundance of experience in most things medical! The radio show allows for people to call in (727-441-3000 or toll-free 866-TAN-1340) or e-mail (DrGigi@skipshow.com) with questions or concerns regarding the medical industry. In the absence of callers, we simply talk about something medical which I think might be helpful for people to know or understand. Though I CANNOT diagnose or treat people via the radio show, I CAN educate them. As opposed to the impact of seeing & caring for one person at one appointment, the radio show offers me the opportunity to touch many people at once.
As an extension of Let's Talk Medical with Doctor Gigi, I intend to use this blog to expound upon issues, & to post information which followers might wish to see in print. I will also use it to "correct" myself... as I am far from perfect, & as live broadcasts inherently lend themselves to occasional errors!
So despite the predictions that the end of the world is near, let's undertake a new endeavor in regards to health. Let's spend some time together... on the radio, or on a podcast, or even on this blog... and Let's Talk Medical! Hopefully it will educate you to take better care of yourself, or perhaps to better understand a loved one's illness. You just might be a better patient, a better healthcare consumer, & you just might learn to be your own best advocate in times of health, as well as illness!
Here's to our health!
Dr. Gigi
PS Happy New Year, & Laissez les bon temps rouler!!!
That's French for: Let the good times roll!!!
And yes, I am from Louisiana!
Because of these concerns & frustrations, I have sought ways that I might educate people to be better at navigating the health care system, & thus to become better consumers of health care. To that end I have been broadcasting a radio talk show: Let's Talk Medical with Doctor Gigi. The show airs on Fridays on WTAN 1340-AM from 3:30-4:00PM in the St. Petersburg/Tampa area. Computer access to live broadcasts, as well as to the recorded podcasts, is available via www.skipshow.com. The format of the show is education in regards to medical issues. This involves any & all aspects of medicine, including preventive care, diseases, immunizations, economics, insurance, & politics... to name but a few! I do not propose to be an "expert" in any of these arenas, but 21 years of active practice have certainly given me an abundance of experience in most things medical! The radio show allows for people to call in (727-441-3000 or toll-free 866-TAN-1340) or e-mail (DrGigi@skipshow.com) with questions or concerns regarding the medical industry. In the absence of callers, we simply talk about something medical which I think might be helpful for people to know or understand. Though I CANNOT diagnose or treat people via the radio show, I CAN educate them. As opposed to the impact of seeing & caring for one person at one appointment, the radio show offers me the opportunity to touch many people at once.
As an extension of Let's Talk Medical with Doctor Gigi, I intend to use this blog to expound upon issues, & to post information which followers might wish to see in print. I will also use it to "correct" myself... as I am far from perfect, & as live broadcasts inherently lend themselves to occasional errors!
So despite the predictions that the end of the world is near, let's undertake a new endeavor in regards to health. Let's spend some time together... on the radio, or on a podcast, or even on this blog... and Let's Talk Medical! Hopefully it will educate you to take better care of yourself, or perhaps to better understand a loved one's illness. You just might be a better patient, a better healthcare consumer, & you just might learn to be your own best advocate in times of health, as well as illness!
Here's to our health!
Dr. Gigi
PS Happy New Year, & Laissez les bon temps rouler!!!
That's French for: Let the good times roll!!!
And yes, I am from Louisiana!
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