Tuesday, December 30, 2014

Healthcare and Vietnam: Loss and Grief

As a Vietnam Veteran and Family Physician, I'm noticing parallels that are bothersome.  Many times recently, I've thought, "This feels like Vietnam"  How?
By the discouragement in the physicians as the transformation of healthcare erodes their autonomy and sense of independence.  It has intensified and dragged down their quality and their spirit.

The "metrics" of the year or quarter or month or week are dumbing down the practice of medicine.  Just like the "metrics" of body counts in Vietnam killed the morale of the American soldier.  They weren't killers and rebelled against the concept of killing people just to have something to count.  We physicians aren't counters and coders as the EMR and a misguided group of programmers and MBA's/ MHA's have labeled and aimed us.

We care and work and serve much more than count and code, BUT we are selling out to the "Numerati" and other numbers/financial geeks.  How much time is left to care and work and serve?

I grieve the loss of the medical profession, just as I grieved for the deep wounds of the Vietnam Veterans, used as killers and body counters by misguided people in Washington, DC.

What do you think?

Direct Primary Care Informational Sessions Dayton, Ohio, Monday January 26 and February 23, 2015

Direct Primary Care Informational Sessions Dayton, Ohio.  

Family Physicians, General Internists, Pediatricians and Med/Peds Primary Care Physicians
and Primary Care Nurse Practitioners, Physician Assistants, Residents and Medical Students:

Monday January 26 and February 23, 2015 at 7:00 PM in the offices of Family Health Connections, Inc 
at 2633 Commons Blvd Suite 120 in Beavercreek, OH:   
Get the latest information about Direct Primary Care.

Sponsored by the Center for Innovation in Family and Community Health (CIFCH).

RSVP to 937-427-7540 (Medical office of Dr Jonas, President of CIFCH).

Is Direct Primary Care the business model to assure your career satisfaction in 
Family Medicine, Internal Medicine or Pediatrics (or Med/Peds)?

Wednesday, December 24, 2014

Pain News and Blog Reviews; Christmas with Autism -Weekly BTR Show

Hi Folks,
On my weekly Dr Synonymous Blog Talk Radio Show I covered several issues, drank coffee and encouraged people to come to the Bluegrass Jam at the BellHOP Cafe in Bellbrook this Saturday 7-10 PM.

I don't know enough about autism.  There is so much to know and so much still missing.  I'll push ahead with more learning.  You may also wish to know more, so I reviewed four sites with autism information and one mother's blog post about Christmas over the years with her son Matt.

Pain News, Family Flu, Christmas with Autism on The Dr Synonymous Show

Last weeks show covered different topics:

MTHFR, B Vitamins, EMR, Clinical Decision Making, Grief at Christmas on the Dr Synonymous Show

A link to the show is always available on this blog site, too.  You have to have a google ID to get into the site, though.

More next week on the Dr Synonymous Show.

(Over 200 shows are archived on iTunes so you can listen to me a lot, if you are so inclined.)

The Flu HURTS!

The Flu HURTS!  It is a PAIN SYNDROME!  That's one big reason to avoid it and respect it. People tend to have pain in their back, head and all over BEFORE the mucous hits their entire respiratory system on the second day.  IT HURTS!

And, there is too much mucous, AND fever every twelve hours or so with increased aches and pains.

And many people, in the midst of the mucous, aches, pains and fevers have the common thought, "if I died, it would feel a lot better".

The Flu is now moving into the Miami Valley  with five or more days of symptoms including sore throat, body aches/ pains, fever and cough.  On day four to six, the infection is often so annoying that the patient or parents seeks medical attention, convinced of the need for an antibiotic, chest x--ray or cough suppressant.

People with chest tightness from tiring muscles plus or minus wheezing seek relief from their painful misery.

Remember Henry The Hand and the principles of hand washing to minimize the spread of the flu.  AND, Don't touch your face!  http://www.henrythehand.com/

Some people just want to get a note so they can get back to school or work when well.  Employers just don't allow a good illness to follow its natural history without involving physicians.  If you know you don't need medical attention, can't you be trusted to decide when you're recovering or recovered?  Is it a covered benefit under your insurance to use a physician when not ill to get a note to return to work?  Can't your mother just write an excuse for your absence?  (No -according to many employer and school policies.  The now functional worker or student must go to a doctor to get cleared for their illness-caused absence, sitting in a waiting room with the coughing people, before their school or employer will believe them as to why they were absent.  What a waste of resources this type of distrust generates.)

- See more at: http://drsynonymous.blogspot.com/2011/03/family-medicine-is-it-flu-strep-throat.html#sthash.4waCI3HF.dpuf

Treatment:  Rest AT HOME!  Don't go anywhere!  You are a threat to others.  Honor yourself and them by keeping away.  Don't go to see doctors or urgent care or emergency rooms, either, unless you really need them for something you and your family can't handle.

Water!  Water! and Water!
Aspirin is a great pain killer for adults with the flu, but may cause death in children because of Reye's Syndrome.  Ibuprofen and acetaminophen may help both adults and children with pain and fever (a temperature greater than 100.4 degrees).  Above 101, the fever adds to the pain.

Cough suppressants, expectorants, decongestants as needed.  Vitamin C 1000 mg may be helpful. likewise echinacea (puerpuera, pallida and augustifolia)..  Vitamin D3 2000 IU daily may prevent the flu, as may the flu shot.  Unfortunately the flu shot only covers three of the many strains and the first one that has hit the area seems to be insensitive to the three strains covered by the shot.  Better luck next year.

I don't think much of Tamiflu, which may shorten the flu by one day- if started in the first forty eight hours of symptoms, but cause mental confusion with delusions or hallucinations at a relatively high cost.

If you have a serious condition and need to see your physician to clarify how to handle the flu in the midst of the serious condition, see your doctor.  You matter.  They can help to clarify how to handle your flu relative to your other disease and all of your medications.

If you see your physician for the flu, don't even think of asking them to handle any of your chronic problems or ongoing medications, etc. while there.  You only need to clarify your flu related issues and get home.  Minimize the exposure to the patients in the waiting room, the office staff and the physician.  

Especially if you are on chronic opiates for a stable pain syndrome, the flu visit is not the time to ask your physician to engage about your pain management.  That is a complex separate visit with all sorts of "quality" and regulatory overtones, way more complex than most people on chronic opiates are respectful of, which is one of the reasons fewer and fewer physicians are willing to treat pain.  People on chronic opiates OFTEN become manipulative and devious and desparate.  The FDA just multiplied by six the amount of time a person on chronic hydrocodone (Norco, Vicoden, Lortab) must visit their physician.  They changed those drugs to a Schedule II (similar to Percocet, oxycodone, oxycontin) which means they can't be refilled or called in to a pharmacy.

If you get a complication of the flu, see your physician.  A complication is whatever you think is a complication.  Especially difficulty breathing, exaustion from coughing, new fever after the fever stage is over, etc.

The flu feels great once it's over.  That's because the Flu HURTS

Monday, December 15, 2014

EMR: Physician Rants

OK, I've heard some physician rants about Electronic Medical Records.  Change isn't always fun.  Here are some rants, just in case you or your physician are all giggles about the EMR, so you know there are other opinions.

"The Electronic Medical Record (EMR) is as "medical" as Medical Marijuana.  But, it helps to maximize "medical" billing.  It costs too much.  It leads to markedly diminished time for patient care.  It is shameful that it was mandated by poorly informed non-physicians.  It is shameful that physicians went along with it.  The idea seemed good, but the EMR doesn't deliver the goods to help patients or hospitals or physicians to improve quality and decrease cost. The new quality isn't quality- it's whatever is measurable.  We sold out our profession and our patients on this misguided transformation.  The Electronic Medical Record is an Electronic Billing Record."

Benefits:  Billing.  Medication lists.  Prescriptions. Legibility.

Harm: Loss of time.  Patient quality.  Patient satisfaction. Physician quality.  Physician autonomy.  Patient-Physician relationship.  Cost of health care.

What do you think?

Tuesday, December 2, 2014

What is Family Medicine?

Medical students have to sort out specialties to be able to select one for their career. Here's the definition of Family Medicine for those who wish to understand how their career dreams compare to a career in this specialty.

"Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity." (1984) (2010 COD).....from the AAFP

During their Family Medicine clinical experience, they may wish to refer to this definition each day to notice what manifestations of the specialty they've experienced or observed.  They may ask themselves:  
"Was that continuity of care I just experienced?  As I see the same patient and members of their family am I developing a comprehensive picture of their health needs?  Working with the patient, are we developing a comprehensive plan for their health screenings and disease care?"

Further information from the American Academy of Family Physicians is the Scope and Philosophical Statement of Family Medicine:  "Family medicine is the natural evolution of historical medical practice. The first physicians were generalists. For thousands of years, generalists provided all of the medical care available. They diagnosed and treated illnesses, performed surgery, and delivered babies. As medical knowledge expanded and technology advanced, many physicians chose to limit their practices to specific, defined areas of medicine. With World War II, the age of specialization began to flourish. In the two decades following the war, the number of specialists and subspecialists increased at a phenomenal rate, while the number of generalists declined dramatically. The public became increasingly vocal about the fragmentation of their care and the shortage of personal physicians who could provide initial, continuing and comprehensive care. Thus began the reorientation of medicine back to personal, primary care. The concept of the generalist was reborn with the establishment of family medicine as medicine's twentieth specialty.

Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.

In the dimension of process, the family physician functions as the patient's means of entry into the health care system and as the physician of first contact in most situations is in a unique position to form a bond with the patient. The family physician's care is both personal and comprehensive and not limited by age, sex, organ system or type of problem, be it biological, behavioral or social. This care is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. When referral is indicated, the family physician refers the patient to other specialists or caregivers but remains the coordinator of the patient’s health care. This prevents fragmentation of that care in both the outpatient and inpatient settings. The family physician serves as the patient’s advocate in dealing with other medical professionals, third party payers, employers and others and as such is a cost-effective coordinator of the patient’s health services.

Although all family physicians share a core of information, the dimensions of knowledge and skill vary with the individual family physician. Patient needs differ in various geographic areas, and the content of the family physician's practice varies accordingly. For example, the knowledge and skills useful to a family physician practicing in an inner city may vary from those needed by a family physician with a rural practice. Furthermore, the scope of an individual family physician's practice changes over time, evolving as competency in current skills is maintained and new knowledge and skill are obtained through continuing medical education. This growth in medical information also confers on the family physician a responsibility for the assessment of new medical technology and for participation in resolving ethical dilemmas brought about by these technological advances.

In summary, the family physician of today is rooted in the historical generalist tradition. The specialty is three dimensional, combining knowledge and skill with a unique process. The patient-physician relationship in the context of the family is central to this process and distinguishes family medicine from other specialties. Above all, the scope of family medicine is dynamic, expanding, and evolutionary.(1992) (2011 COD)".... from the AAFP

The personal experience of the students allows them to discern how well their dream and their sense of the specialty of Family Medicine align.  It's not for everyone, but it is the specialty for many.