Thursday, January 26, 2017

Family Medicine: Clock Management

OK, Family Docs, what percentage of the time during your usual office clinical encounter is used to directly relate to the patient?  What should it be according to your dream of the best physician you can be??  What should it be according to your employer if you have one (or two or whatever)?


Thursday, January 12, 2017

Direct Primary Care Ohio UnSummit V Feb 18, 2017 Columbus

Direct Primary fans in and around Ohio will be pleased to hear more about the next UnSummit coming up in February on the OU Heritage Medical Campus in (West of) Dublin, Ohio- a Columbus suburb.

Speakers will review the two major training models/schools which are in Kansas and North Carolina.  They will speak about DPC for medical students and residents, and DPC for early career physicians.  We'll discuss mid-career and late career DPC start-ups and transitions.
Ohio DPC physicians will introduce their perspectives from several areas of the state.  Pearls and Pitfalls are always fun, and sometimes worrisome, to discuss, but we'll do it anyway.

New this year will be "Medical Marijuana" in Ohio and DPC.  Also new will be discussion about what to do as a side job or moonlighting if necessary to fund your DPC path.

Favorites that will be presented in update fashion are "DPC for Geezers", "DPC National Online Tour", "My DPC Practice" (panels of physicians).  DPC networking in and around Ohio.  Legislative update.  "Why we don't/do need to regulate and control DPC".  A Townhall session will close out the day.

No CME credit is available for this meaningful day.  More later, like how to register (for a mere $150, less for students and residents) will be in next weeks blog post.

Follow the Facebook page of main sponsor The Center for Innovation in Family and Community Health for continuing commentary about this opportunity.  Facebook Page CIFCH
Flyer and Registration Form DPC Ohio UnSummit V


Wednesday, December 21, 2016

Care and Caring with My "New" Knee at The Soin Medical Center

I love the Soin Medical Center in Beavercreek, Ohio!

There is a great team of caring, competent health care professionals in the Joint Center in the Soin Medical Center.  My right knee volunteered to need their services with a total knee replacement.  Dr. Aram Donigian orchestrated the surgery with a very engaging and connected operating room team.


The Soin environment offers a small town atmosphere, which I love.

For the day of surgery, the nurses, doctors, nurse practitioners and OR personnel were highly focused and organized.  I noticed stainless steel hammers and other carpentry-like tools in the OR - then stopped looking.  I sort of didn't want to know too much.

The spinal analgesia calmed my entire being and the propofol gave me sleep and the next thing I knew, I was waking in the recovery room with Nurse Shelby, who exemplified the Soin spirit.  She was energetic, caring, honest, helpful, supportive and competent.  I had the laughter that wouldn't quit and no pain in my right knee.

Now on the mend with great nurses, PT's, OT's and Nurse coordinators etc., I am being discharged and continue to sing the praises of the Soin Joint Replacement Team.

What a great example of Resilience!

They help each other to get the job done. And they Care.  And they care.  And they care.

More later about other aspects of this adventure.  Here's my BlogTalkRadio Show about it: Click for more  Dr Synonymous New Knee at Soin Medical Center


Saturday, December 17, 2016

Vaccine Pot Pourri

Warning:  If you come to my medical practice, you may be exposed to un-immunized or "under-immunized" children. 

I believe that informed parents are the ones who make healthcare decisions for their children.  Ohio is one of about 13 states that allow parents to accept or refuse any or all recommended immunizations, so parents are in the drivers seat about vaccines.  "Informed Parents" is a key concept in this process.  Physicians are obligated to help the parents to understand the diseases and immunizations in question.  This is a process, not an event.  It is helped considerably by information access via the internet.  We can review information from the Center for Disease Control (CDC): vaccines and preventable diseases and who should not get these vaccines to clarify some of the basic information and go to many other sites to explore further information as desired by the parents.

These discussions are important but often very complex.  Many physicians are time constrained from going very far into the discussion.  A few are angered by parents who don't accept whatever is recommended enthusiastically.  Most parents are pleased to have the vaccines for their children.  Many want to hear more about the potential benefits and harms of the vaccines.  A few want to know more about the potential dangers (and benefits) of the diseases versus the risks and benefits of the vaccines.

I like vaccines for most people.  I like freedom of choice, too.  The concept of the "Greater Good" is a balancer in public health and in medical decision making about vaccine preventable diseases and vaccines.  These concepts go back to the principles of medical ethics, which I reflect on every day.  

  • Principle of respect for autonomy,
  • Principle of nonmaleficence,
  • Principle of beneficence, and.
  • Principle of justice.

I encourage you to look up the Principles of Medical Ethics for an array of definitions of these terms.  Decisions can be shrouded in gray from time to time and generate considerable discussion.  Vaccines versus genetic vulnerability to negative effects of vaccines is a challenging and complex discussion that is often overlooked or misunderstood.  The CDC is sensitive to this issue, but more front line genetic information is needed to identify the small group of vulnerable children and adults who need to stay away from certain vaccines.  The changing nature of microbes is another challenge, especially pertussis.  How do you immunize people from a disease that keeps evolving?

"The ideas that everyone has to get vaccinated for the “greater good,” and that it is acceptable for some children to be sacrificed for the welfare of the rest, does not feel quite right when one-size-fits-all vaccine policies end up targeting the genetically vulnerable as expendable."  From:

Barbara Loe Fisher


We are confronted with many diseases while we are blessed with some great vaccines and some great freedoms.  At the confluence of these, each individual gets to decide how to proceed.  Physicians, patients and parents have responsibilities to do our best to help each other and our society.

What do you think?

Wednesday, December 7, 2016

Know Brain Know Pain: From Genomics to Guts to Gardens

Here's the Power Point slides from my presentation at the pre-symposium Seminar for the institute of Holistic Leadership: Know Brain Know Pain

Here's the outline of the first few slides.  I'll review thers on my Dr. Synonymous Blog Talk Radio Show after my knee surgery calms down in a couple weeks.

The cannabinoid receptor agonists (health foods that stimulate cannabinoid receptors in the body) are promising for pain relief for many.

Know Brain
Nucleus Accumbuns
Caudate Nuclei
A Fibers
C Fibers


                             •Know Pain
Acute vs. Chronic
Wind Up
Hyperalgesia
Raw
0 to 10
“Twin Towers” of Pain

                       •From Genomics
Human Genome Project
23 & Me, etc.
New Information
Overwhelming
Front line usage clunky
Hopeful with IT/ EHR

                       •To Guts
Human Microbiome Project
Good Fats, Prebiotics, Probiotics
L. Helveticas, B. Longum
Wheat Belly, Grain Brain
Grains and Sugars
Skinny People Poop

Breakfast Via Ninja
Protein Powder & Greens
Flaxseed, Hemp Hearts
Super Collagen Powder
Maca Boost Powder w/Rhodiola, Ginger, Theobromo Cocao
Citrulline Powder
Berries, Almond Milk, Kefir


To Gardens (Or health Food Stores)
Only Response to Genomics
Medicalized by “Medical Marijuana”
All will know of Cannabinoids
And Endocannabinoids
And CB1R and CB2R and “CB3R”, etc.
Fermentation, Sprouts, etc.

          •Vitamins and Supplements
B Right, C, D3, Coenzymated MVI
Omega 3 fish, Cal-Mag-Zinc, K2
Selenium, Tri-Iodine, NAC,
Curcumin, SAMe, CoQ10, Pycnogenol,
DHEA (over 50)
Probiotic 10-20
          •“Medical” Marijuana in Ohio
Is NOT “Medical”
Will Cause Solutions to Opiate “Crisis”
Solution to “Obesity Epidemic”
Will drive physicians to Health Foods
Is Dangerous, too

          •Beighton score
Connective tissue Disorder Spectrum
BJHS
JHS,
EDS Ehlers-Danlos Syndrome
Marfan’s Syndrome
Etc.

           •Brighton Criteria