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

Wednesday, January 17, 2018

Only Rock is Real: Discussion and Interview with Author Sandra Miller, MD

Dr. Jonas, your host for The Dr. Synonymous Show interviews Sandra Miller on January 21, 2018 about her delightful novel, Only Rock is Real.  The novel deftly combines a geographically and medically accurate setting with astronomy and dynamic human relationships to deliver a message about the life of a woman physician.  Yes, gender matters - to all of us - and Dr. Miller knows it.  She develops her characters and connects them to other characters and situations then sprinkles in the Grand Canyon, The Grand Canyon Clinic on the South Rim and the heavens.  Wow!

I loved the book.  I do want to visit the Grand Canyon as a result of reading her perspective about life, love and medical practice on the South Rim.

Snakebites, gunshot wounds, brawls, dehydration, heart attacks, grief reactions, pneumonia, coccidiodomycosis and more medical conditions are daily fare for Dr. Abby Willmore and her clinical boss, Dr. Pepper.  Jake Peterson, park ranger, spices up her life, which is clouded with a history of panic attacks and alcohol abuse (maybe self-treating the panic?).
Tune in to the Dr. Synonymous Show on Blog Talk Radio to learn more about the book and the author.  We'll have geology, astronomy, Family Medicine, geography, clinical situations and even sex/intimacy/love to discuss.

Click here to tune in live at 9 PM eastern on Sunday January 21, 2018 or you can listen to it anytime on Blog Talk Radio by clicking for the next few years.

General author questions that I might ask include:

How did you decide to write novels?  Why this subject matter?

What is your geology background?  How did it change with your experience in the South Rim?

How about the same with your astronomy background and interests?

The tension among and between the characters in your book and the environment seems to work well, at least for me as a reader.  How do you decide on the tension levels and situations?

The amount of pain and suffering was OK for me as a physician reader, although I could feel one of the situations intensely.  What feedback do you have from other readers about the pain and suffering of characters, patients, etc?

How do you decide what limits to put on the development of Dr. Abby Willmore?

How do women in medicine respond to your writing about Abby?  How does the Abby Willmore, MD character seem to compare with relationships, dating, love, reproduction, etc. in women physicians you've known through the years?  How do you decide how far to go with writing about the intimate/sexual situations?  How many attributes can you toss into the life of such a character?

Thanks for integrating the medical student and resident physician roles into the clinic.  My first multidisciplinary experience in medical school at Ohio State was through the U of Az. in Marana, Arizona at a Community Health Center with nursing and pharmacy students.  A nurse practitioner named Pat was the boss.  We had a mobile clinic that we took to schools and a small village or two.  An internist from Johns Hopkins was serving his NHSC commitment there.  The pharmacy and community board of directors were other key elements.  There was a church next door and a mobile home for loan around the corner where I stayed with my wife and two very young children.  Cotton fields were vast and seemed to be everywhere.  It was a powerful experience.

How long does it take to write a novel?

How many do you have going at once?  Or are they sequential?

With your thousands of patient experiences, how do you decide which types will be included in the books?  What about one of a kind experiences- how do you mask them in your writing?

What else do you want the listeners to know about you or your work?

How can they buy your books? Books and Writings of Sandra Miller, MD

Sunday, January 7, 2018

Mission Chechnya, New Novel by Therese Zink, MD Interviewed on Internet Radio 1/8 at 9 PM

Link to interview with Therese Zink, MD about her new novel: Mission Chechnya  on 1/8/2018 at 9 PM live or anytime after that through the link above.

Dr Jonas, your host for the Dr. Synonymous Show, is delighted to get to interview Dr. Therese Zink again about her newest book, Mission Chechnya, a novel reflecting many of her insights about that area of the world and global health issues.  She will discuss the origin of the book, its background and her own, and her passion for writing and global health.
The book starts with a birth in the airport bathroom and moves from there to provide perspectives  on health needs and issues in Chechyna through well described characters. 
General questioning will include these type questions: 
How did you come to be a book author?
Are you a reader, too?
How often do you write?  What's your schedule?
Why this book?
Why these characters?
How do you decide on the depth of character development for these people?  I was impressed by the developmental detail of characters, situation, themes, etc.
How should global health be addressed?  By whom?
Once you're global, can you ever be local again?
How does Wright State BSOM introduce and promote global health and global health service?
How does a senior Family Medicine Scholar, Author, Leader operationalize global health interests/commitments?
How much fun are you having?
What's the process for promoting and selling books that you've authored?
How can listeners and readers get the book?