Friday, September 26, 2014

Patients and Family Doctors

Where are we doctors without you?
You are a health expert.  You know how to get sick.
You know how to take care of your self.
Up to a point.

You know our office staff.
You know our magazines.
You know Dr Google and Web MD
You do self care well.
Up to a point.

You know your story.
You know your support system.
You know how you cope with illness and adversity.
You know what we do.
Up to a point.

We know our medical system.
We know how to doctor.
We know how to care.
We know how to comfort.
Up to a point.

We know medicines.
We know hospitals.
We know other specialists.
We know laboratories.
We know imaging centers.
Up to a point.

We know that you matter.
We know that you may need help when you're ill.
We know how to listen to your story.
We know how to validate your worth.
Up to a point.

Together, we find meaning.
For our lives.
For our illnesses.
For our coping strategies.
For our ultimate demise.
Up to a point.

We comfort each other.
We honor each other
We confide in each other.
In our own way.
Up to a point.

At the point of connection.
At the point of respect.
At the point of shared humanity.
At the point of wholehearted contentment.
At the point of God's Creation
Within which we share as patient and doctor,
Human and human, teacher and learner,
learner and teacher, steward and steward.
Heart to heart.
There is a piece of God.

Tuesday, September 23, 2014

Humans and Tech: Will it Work for Family Medicine?

"By People, For People" Velocity NY 2014 Keynote by Tim O'Reilly.  Tim gives a great message about the human element in tech starting with  We can learn a lot about the human element, leadership and tech from him.

Is this the message for Family Medicine. Get back on the horse and reconnect the human aspects of health care?

Will IT listen?  I believe the people in IT will. Let's hug IT folks and move ahead together.  The Human Centered Health Home (HCHH) is an example of how to apply human centering in patient care.  Search this blog site for my many posts about it.  One point in human centering is that we are all in this together.  Human to human we can Respect, Protect, Connect, Detect, Correct our situations and Reflect on them individually and together. Posts to Define HCHH

Hug IT now!  You may come up with something as good as Elation EMR ( which allows human elements of the encounter to come out.  They have very helpful humans like Vanessa Rodgers and Drew Varady in their company, too, which is the essence of what Tim O'Reilly discusses above.

Hug IT now!  It's time to move ahead together.  Family Medicine will use it well if we develop it well.  If we wait for someone else to do it, we may lose.  We have the heart that the electronic part of medicine needs. Let's take the next step to prove it.  Dive into an EMR and give it a heart if it's missing.  Get connected to high tech, low price front line health care items, like the cell phone ecg and have more fun than you can stand.

High Tech, High Touch.  Sounds like Family Medicine to me.

Hug IT now!

Thursday, September 18, 2014

Thanks, Readers for 100,000 Page Views

Bloggers enjoy writing, at least I do, and readers.  Thanks to the many Dr Synonymous readers for 100,000 page views.  It tells me that there are readers of the blog and reassures me that I should keep writing.

Family Medicine is my main message.  I love Family Medicine and doing what Family Doctors do.  I'm passionate about the importance of my specialty for the health of individuals, families and communities (and the nation).  I still believe we have a lot to offer during and after the transformation of health care.  I'll write more about it.

Patients are even more interesting, and more important, than Family Medicine.  Their stories are meaningful and compelling.  Their lives are sometimes misaligned with their values, goals and dreams.  I enjoy validating their worth and helping with the "realignment".  I try to write about our shared humanity and the process of care.

Thanks again to Mike Sevilla, MD aka, Dr Anonymous (The "King" of social media in Family Medicine) for leading the way.

More later.  Thanks, Readers.

Monday, September 15, 2014

Chicken Pox, Vioxx and Goldilocks: Avoiding Avoidable Health Care

Where is health care headed?  Where has it been?  What can we do about it?

Think about Chicken pox.  Everyone gets them.  No big deal.  But wait.  There's an immunization now, given to one year old and every ten years thereafter (a booster).  Barely anyone gets the chicken pox these days. If someone wants their child to get exposure to someone with the chicken pox so the child can get the infection and by pass the immunization and boosters, it's almost impossible.

Think about Vioxx.  Great pain killer.  But wait.  A large number of users had a heart attack or stroke when they took Vioxx.  Many died.  There was a huge settlement from the manufacturer to patients or their families for damages.

Goldilocks and the Three Bears is a well known fairy tale.                                                                          

What do chicken pox, Vioxx and Goldilocks have in common?

What do you think?

More later.

Thursday, September 11, 2014

Holistic Strategies for Health 2014

Holistic Strategies for Health, Enhance Your Brain and Heart Through Wholeness

Facilitator:  A. Patrick Jonas, MD

Find holistic strategies from the four major NIH categories of Complementary Practices for yourself that enhance your health.  Improve your sense of wellbeing by better understanding how your brain and heart are involved in wholeness. Review:
Mind-Body Strategies
Neutriceutical Therapies
Body Therapies and
Energy Therapies.
Find four of these that fit your style and need.
We'll have fun as we discuss these strategies and help you personalize while sharing with other attendees. We'll use a very interactive learning style in this session.  You already know a lot. 
Review of our holistic journeys

            Wholeness promotes holistic thinking- and human/spiritual connection
            From 60 trillion cells, each w/100,000 chemical reactions per minute
            1 billion + new cells daily, 1 of which is a malignant mutation
            How is it held together? How do we help/ harm ourselves?

Overview of NIH National Center for Complementary and Alternative Medicine
    (Practices not “Medicine”)

            Complete Systems of care such as Traditional Chinese Medicine, Ayurveda, Homeopathy, etc

            Mind Body Therapies/ Practices
            Neutriceutical Therapies
            Body Therapies
            Energy Therapies

Aspects of Wholeness:   The Bible
Molecules of Emotion  by Candace B. Pert, PhD. Every thought/ feeling affects our white blood cells/ immune system immediately.  T Cells and Natural Killer Cells.

 Vibrational Medicine for the Twenty First Century by Richard Gerber, MD.
The Biology of Transcendence and The Death of Religion and the Rebirth of Spirit by Joseph Chilton Pearce, PhD.

Wheels of Light by Rosalyn Bruyere; Hands of Light by Barbara Ann Brennan
Changing with NLP by Lewis Walker;  Time Line Therapy by James & Woodsmall

The Body Electric Robert Becker, MD & Gary Selden; Healing is Voltage by Jerry Tennant, MD “Coherence” balancing the autonomic nervous system Life Extension Foundation- Top Twelve Supplements Recommended Sound Atunement Therapy

Examples and Exercises:
            Neurolinguistic Programming (NLP); Hypnosis
            The “5-5-5”.   The vegetable/ herb garden.  The health food store.
            Massage; Chiropractic; Rolfing
  Quick Coherence Technique; Breathing; Relaxation
            Singing Bowls; Drumming; Didgeridoo, Music Therapy, etc.
            Touch; Exercise Ball
            Reiki; Reflexology; Holistic Chair Massage; Dry Needling; Acupuncture
            Prayer; Meditation

General Health and Wholeness

Monday, September 1, 2014

High Tech, High Touch: Technology to Recharge Patients and Family Physicians

I wrote this for the Ohio Family Physician about four years ago.  It's still a message about one of my favorite mechanical health strategies.  I use it a few times each month to get more wholehearted (attempting to balance the autonomic nervous system.)

By A. Patrick Jonas, MD from my article in The Ohio Family Physician

Cardiovascular disease is still the leading cause of death in America. Strategies to decrease the incidence of premature heart deaths are improving. Stents, medications, exercise, diet, etc. are well known interventions.  Biofeedback strategies for controlling blood pressure and stress were popular in the 1970-1990’s, but lost out in the reimbursement wars and disappeared from common use.  With enhanced understanding, those methods are making a comeback, even with some support from the Professional Golfers Association (PGA).
Golfer Nick Doherty had a habit of “choking” on the last day of pro golf events when he was in contention.  A few years ago, he forgot how to choke and became a very effective golfer late in competition.  When other golfers pressed him for his secret, he let them know he was using a biofeedback technology from, called emWave Personal Stress Reliever and emWave Desktop.  These tools, now used by golfers around the globe, enabled him to be calm and focused under pressure.

Family Physicians are professionals under mounting pressures from outside forces in the health care system as they notice extra pressures in and from their patients.  The focused office visit to manage the high blood pressure is often stretched by the patient into a four or five problem encounter, sometimes trivializing the importance of the blood pressure and its complexity.  The sudden addition of the need to “refill” prescriptions for allergic rhinitis, asthma, gastroesophageal reflux disease (GERD), and the shampoo originally prescribed by their dermatologist add to the stress of the family physician and increase the risk of burnout.  While there are many reasons for these daily events in family medicine practices nationwide, there is no denial of the increased stress in the lives of family physicians and their patients.  With the addition of healthcare transformation and the shift to the Patient Centered Medical Home (PCMH), the stresses havel increased.

Could family physicians and their patients benefit from technology that helps golfers? Could the same technology enable both patient and physician to lower their blood pressure?  Studies support the use of the emWave biofeedback technology to lower blood pressure, improve sleep quality and even help many with poor eating habits when under stress.  In fact, family physicians are all trained to have insights about, and have strategies to help patients with, stress induced symptoms and diseases.  The EM Wave builds on that knowledge with information from neurocardiology about the impact of stress on the heart and subsequent effects on the limbic system, especially the amygdala.
One measure of heart-brain connection is heart rate variability (HRV), commonly used to monitor the wellbeing of unborn babies during labor, but also used as a measure of autonomic nervous system function.  Heart rate variability changes from second to second as our thoughts change.  The amygdala is continuously scanning our emotional memory to compare our current situation to past situations.  If a current pattern matches a past stress inducer- boom- a stress response is turned on to protect us.  This immediately decreases the quality of our cognition (test anxiety, anyone?) and increases heart rate, blood pressure and respiratory rate, among other elements of the response.  If our patient is having increased stress reactions and we’re trying to help them with the resulting blood pressure and get to the bottom of a stress reduction strategy, we get our own stress response when they deflect our efforts with the request for the four unrelated prescriptions.  We both need help!

The HRV synchronizes with the amygdala, sending messages from heart to brain and brain to heart.  If the HRV is “coherent” indicating a balance between sympathetic and parasympathetic nervous system elements of the autonomic nervous system, the amygdala is content to allow contentment.  If the HRV is chaotic, the amygdale finds an emotional state in memory that matches that HRV, generating a negative emotional state with a stress reaction, affecting the entire brain and body.
The HeartMath people have a “quick coherence technique” to teach people how to decrease the stress and re-balance the autonomic nervous system.  It has three simple steps that also are used with their software for skill training:
“1.  Heart Focus:  Shift your attention to the area of the heart and breathe slowly and deeply
2.  Heart Breathing:  Keep your focus in the heart by gently breathing- five seconds in and five seconds out- through your heart. Do this two or three times.
3.  Heart Feeling:  Activate and sustain a genuine feeling of appreciation or care for someone or something in your life.  Focus on the good heart feeling as you continue to breathe through the area of your heart.” (Wilson and Childre, 2006)

The beauty of the quick coherence technique and having the ability to become coherent in even the most stressful situations is that the patient or physician employing the skill need not be in a trance-like state.  This is not relaxation therapy.  They can be totally present and contributing with their best brain and heart function in full support.
The desktop version of the EM Wave Desktop includes a breathing trainer and games such as flying a balloon or painting a meadow with your coherence.  Several screens in the software enable the user to see a lead II of ECG, coherence scores, autonomic nervous system moment to moment balance between sympathetic and parasympathetic elements, and previous sessions for the same user.  Multiple users can use the same software which is totally self instructional down to the basics of HRV and stress.

Booklets about using the system to approach specific conditions are available on the web site where the EM Wave is sold.  These include, The HeartMath Approach to Managing Hypertension, Transforming Anxiety, Transforming Stress, Transforming Depression, Managing Emotions:  Golf’s Next frontier Booklet.

There are many ways to relate to stress reduction and blood pressure reduction.  The use of electrophysiology and biofeedback may help many family physicians and their patients to avoid or manage stress related diseases.