Sunday, September 23, 2018


Malaise is defined as "a condition of general bodily weakness or discomfort, often marking the onset of a disease. a vague or unfocused feeling of mental uneasiness, lethargy, or discomfort."

I love the word.  I even appreciate experiencing it every year or two for 34 - 48 hours.  I have it now.
With myalgias - muscle pain.  Everywhere.  Similar to the first day of the flu.  But without the mucous in the head and lungs with the intense cough of the flu, fortunately.

The feelings of malaise and myalgias are caused by the white blood cells bursting and allowing interferon to float through the circulation.  Maybe it's part of the grand design to keep us away from other people when we're infected, to minimize the spread of contagious microbes.


Sunday, June 17, 2018

Direct Family Medicine: More Thinking and More Fun

What do doctors do when they no longer have contracts with any insurance companies?  They spend more time with patients, they think more and they have more fun being a physician.

We terminated all our commercial insurance contracts December 31,2017 and all remaining Medicare contracts on March 31, 2018.

Our patients could opt for our Direct Family Medicine subscription option or pay cash for their visits.  All new patients are only offered the subscription practice option.

We now have openings for 300 new patients who are interested in having a physician who will listen to their story and work with them to maintain or regain their health.

We get to think clinically with more of our time now and pay less attention to insurance or government initiated administrivia.  Medical Practice is more fun with this model.

Many physicians are getting burned out and frustrated.  They aren't having fun.

We're Neighborly Family Medicine now and we're still having fun- only more.
More later.

Wednesday, June 13, 2018

Decision Making in Medical Care: Interview of Dan Jonas, MD, MPH

How are decisions made in medical care?
Dr. Synonymous (A. Patrick Jonas, MD) will interview Associate Professor Dan Jonas, MD, MPH about this subject on the Dr. Synonymous show June 14, 2018.

Dan teaches courses at the University of North Carolina to medical students, physicians and public health graduate students about analyzing the medical and other scientific literature.

Full disclosure:  He is my middle son.  I'm very pleased with how he has used his gifts and talents.

Dan will review his background.

What are the courses he teaches?  What excites the students?  What surprises them?  What is changing with time and technology?

We'll talk about studies- how big do they have to be to count?

Evidence:  What is it?  What is "Evidence based" and what isn't?

Patients role in medical decision making:  What is it?  What could it be?

Basic Science versus Clinical Science:  How do medical learners process information early and later in their careers?

I'm a (holistic) family physician and Dan is a Med-Peds and public health trained academic physician, so we'll focus on primary care types of examples during the interview.

Chronic disease care (management) versus acute illness care:  What are similarities and differences?

Public Health versus Personal Health:  What are some differences and similarities?

Quality:  What is it and who decides?  How is it measured and reported?  What is patient role in defining quality?  Wheat Belly and Grain Brain.  The microbiome-Quality vs novelty.

Electronic Medical Records:  Benefits and Harms (Remember principles of medical ethics and physician burnout)?

Common versus rare diseases:  How are they found, followed and treated?  (We'll comment about Ehlers Danlos Syndrome among others)

Time management in clinical care versus clinical decision support (tools, etc.)?  Front lines versus ivory tower.

Direct Primary Care versus Usual Primary Care and other models:  How do we change?

How many studies are what level of quality?

Genomics:  Quality studies?  Consumer driven  genomic information as a source of quality and/or physician annoyance?

Click Here for the Interview

Saturday, February 3, 2018

Family Medicine: Is it All Medical?

The Coroner called.  Someone died.  Will I sign the death certificate?
The note was attached to the front of a thick chart.  I saw the name.  "Why would he die?"  I thought and a microsecond later I had the probable causes of death in mind.  It was not a real surprise.

They would come together for their visits.  One stayed in the truck with their dog while the other saw me, then they switched places.  The last two visits, the dog was in the exam room.  Six months ago, all three were in the exam room for her visit.  She was progressively sicker with recurrent hospital admissions which were getting closer and closer together.  He knew he had to be present that time. She didn't survive the next admission.  I had mentioned hospice as an option on three occasions and they opted to follow the full pathway with ICU's, ventilators, home BIPAP, etc.  The home BIPAP added five years to her life (five years of life after I initiated the first hospice conversation) and amazed several of us.

He brought the dog to his last visit, too.  He was lost without her.  Could the cause of death be a "broken heart"?

Family physicians are aware that sometimes the death of a spouse is followed by the death of the surviving spouse within a year.  In couples who are very close, a "broken heart" may be a significant factor in the second death.  It isn't a medical diagnosis, though- it can't be on the death certificate, which is restricted to medical diagnoses.  Too bad.  Things like "Old Age" aren't allowable, either. All deaths are "medical".  Too bad.

In Family Medicine, we develop insights about people that go beyond "medical" phenomena.  It's part of our essence-- knowing people, and their stories, and their meaning.

Thursday, February 1, 2018

Staying Alive

Now I lay me down to sleep
I pray the Lord my soul to keep
If I should die before I wake
I pray the Lord my soul to take

God bless Mommy and Daddy and Grandma and Grandpa Jonas and Grandma and Grandpa Clayton
and thank you for Jesus.  Amen

I flash back on that prayer taught by my mother and father to my brother and I, as my mother is in her last day or so of life (here in my home).

I held her hand and prayed The Lord's Prayer for her with son Patrick a couple hours ago.  She was smiling and looking to the heavens with such contentment, somehow ignoring her body and somewhat labored breathing.  She doesn't seem to need the body any more.

Oops!  She overcame the labored respirations and it's now 2/1/2018--I started this post in September, 2016.  I'm amazed at her resilience and whatever has sustained her life to be entering her 21st month in hospice care.

What is the secret ingredient that has some dying and others living?  She is bedfast and totally dependent on others for everything outside of her body.
More later