Sunday, January 31, 2016

Biographic Information on Dr. Synonymous

Dr. Synonymous is written by A. Patrick Jonas, MD ABFM.
Someone asked for some information to introduce me, A. Patrick Jonas, MD, for a presentation.  I started to make a few notes, then noticed that it was a bit long.  So I wrote a shorter version and then an even shorter version.  Here are all three sets of information.  I decided to post it on the blog so those who are interested can read it and most can ignore it.  Believe it or not, I left out a lot.

Brief option for introduction:  Dr. Jonas is a Family Physician with a vast array of experience, including about 190,000 patient encounters.  He's still having fun.

Short option on the introduction:  Local origins to West Point to Vietnam flying helicopters to OSU COM to Penn State for Family Medicine training to practice in Granville adding college health and sports medicine at Denison U before a full time faculty stint at OSU then Kettering Medical Center as Director of Family Medicine Education followed by another private practice in Beavercreek from 1999 to present, with the addition of Open Arms Health Clinic in Bellbrook.  Still having fun as a Family Physician. And a social media geezer.  And picking the banjo and playing the didgeridoo.

My background longer form:
I'm a Holistic Family Physician and Scholar practicing in Beavercreek in Family Health Connections, Inc., a practice that I own, and the Free Clinic in Bellbrook- Open Arms Health Clinic - in which I'm Medical Director and Board President of the all-volunteer 2 year old adventure (now also supported by volunteer members of AED).

I grew up in Liberty, a town of about 80 people, counting dogs and cats, eight miles west of Downtown Dayton, went to Jefferson Township High School, then graduated from West Point in 1968 followed by Army Ranger, Airborne and Rotary Wing Aviator schools and a free trip to Vietnam where I flew helicopters supporting the Army Corps of Engineers (which was my Army Branch).  After two years as an aviator and small unit commander at Ft. Riley, KS, I went to OSU College of Medicine on the three year track in the class of 1976.  Chocolate then called me to do my Family Medicine Residency in Hershey, PA at the M. S. Hershey Med Center of Penn State University.  The Three Mile Island nuclear reactor partial melt-down helped with our decision to come back to Ohio to practice in Granville, home of Denison University, for 11 years.

Private practice, clinical precepting at the OSU Department of Family Medicine weekly, doing college health and sports medicine for Denison- where I was Medical Director of the health center and Head Team Physician for 11 years -  was followed by full time faculty status at OSU in 1990 to restructure the Department of Family Medicine when regimes changed.  We succeeded so well that OSU was named one of the top five primary care med schools in the nation two years in a row by US News.  OSU was so surprised that they dismantled the leadership of the department in 1994 and I came to Kettering Medical Center to develop Family Medicine Training affiliated with Wright State.

When regimes changed there, I started the current practice in Beavercreek and picked up an array of holistic skills which complement traditional Family Medicine, including Reiki, Aromatherapy, Reflexology, Holistic Chair Massage, Non Directive Imagery, Neurolinguistic Programming, Sound Attunement Therapy, and others.

For 35 years, I've been a Family Fanatic, still owning the only practice in Ohio that only takes families.  Yes, the whole household signs up, making the Human Genome a daily activity in my practice - and now we're playing with the Microbiome.  And we have fun. 

Halfway through helicopter training, I was smart enough to marry a mid 1969 UD graduate who I knew since the eighth grade.  We have three sons, two of whom are physicians- a hospitalist at Ohio State and a Medical Faculty at UNC in Chapel Hill, NC who is director of their Center for Evidence Based Practice and member of a pharmacogenomics research team.  The oldest son does billing, coding and business activities in my practice which my wife coordinates.

I pick the banjo, write songs, sing in the church choir and just started to lead the men's group at the Bellbrook United Methodist Church. I was named one of the top 20 Family Physicians on Twitter by Medical Economics Online.  I am a social media geezer with two blogs, a weekly internet radio show, four facebook pages, and a few YouTube videos of some of my songs.

I'm also active in medical leadership having served as the President of the Ohio Academy of Family Physicians and currently as the Greene County Delegate to the Ohio State Medical Association House of Delegates.  I'm rounding out with a state and national leadership role in Direct Primary Care, a business model that eliminates 40% of the cost of overhead for primary care physicians, giving them back the dream of serving patients in a way that both patient and doctor deserve.

I'm still having fun, and you can have fun, too. I care deeply for my patients.  I get to laugh daily and cry weekly.  (How much you care is how much you can hurt).

I love what I get to be and do.

Thursday, January 28, 2016

Direct Primary Care Secrets (Time and Relationships)

My BlogTalk Radio Show January 26, 2016:  DPC Secrets
Dr. Pat Jonas, your host on the Dr Synonymous Show, will discuss Direct Primary Care again focusing on some DPC secrets that make it appealing.  Time, Time, Time.  Expanded Differential Diagnosis.  Depth of personalization.  Even genomics.  Even eating strategies. Time, Time, Time.
Eating for Health.  Learning from Dr.'s Davis and Perlmutter.  Probiotics:  Eating microbes to seed the intestinal flora and Prebiotics:  Fiber that feeds our intestinal flora.  What is it? Why is it important?
Dr Jonas will also comment on the DPC Ohio UnSummit IV to be held in Dublin, OH on February 20 from 8:30 until 4:30.  We'll have some fun learning and sharing about DPC.
Blog and Tweet Review as usual.  Connect in our chat room.

Wednesday, January 27, 2016

The War and The Wall and West Point

Forty-three years ago today, the Vietnam Peace accords were signed and there was a cease fire.
Here's President Nixon announcing the peace:
Nixon Peace with Honor Speech

As a Vietnam Veteran, I reflect on my experience and our nation's experience in Vietnam.  I write about it every year.  I read about it five or six times a year.  I look at two shelves worth of books about Vietnam in my home office every day and think briefly about the war and its meaning.  And the twenty members of the West Point Class of 1968 who died in the war.  Their names are on The Wall.

The War, The Wall and West Point.  The confluence of many lives and deaths.  The sources of deep, intense meaning.  The origins of human connections that last forever.

Who has the answers?  Who has the questions?

It goes on and on.

I pray for peace in the hearts of all involved and affected by the "Conflict" in Vietnam.  Amen

Thursday, January 21, 2016

Family Medicine: A Quiet Revolution

The midnight special January 21 Dr Synonymous Show on blogtalk Radio is a call for realigning with the essence of Family Medicine which I review on the show, sometimes passionately ranting about "meaningless use", bonus based medicine and evidence based medicine.

"The Secret of Quality is Love" click to listen to the show.

Dr Jonas, your host, holds a late night session about morbid measurement and murderous metrics which are killing healthcare.  The NYT article "How Measurement Fails Doctors and Teachers" by Robert Wachter in the Sunday Review is a timely message of importance to the nation.  We will discuss it.
How does this relate to Family Medicine?  Many ways.  We have abandoned our essence as if it is unmeasurable fluff.  We have agreed to be measured by wigeteers and come up short for our patients.  Patient autonomy be damned and meaningful use be honored seemed to be our motto.  We failed to exert the leadership that would protect our patients from massive amounts of bonus based healthcare.  The EMR outranked medical ethics.  Is there hope for Family Medicine and our patients?

Yes, if we become Quiet Revolutionaries.

Yes, if we reaffirm our essence as Family Physicians.
Yes, if we stimulate a dynamic dysequilibrium in healthcare that allows patient autonomy to be honored again.
Yes, if we move away from "meaningless use" of patients and resources.
Yes, if we seize, retain and exploit the initiative of the Direct Primary Movement.
Yes, if we stop selling out to hospitals, insurance companies and Big Pharma.
Yes, if we celebrate the fun of neighborly clinical decision making, by integrating patient values into decision processes.
Yes, if we honor each other as scarce, valuable resources.
Yes, if we stop using so called evidence based medicine as a weapon.
Yes, if we nurture the pipeline that feeds our specialty and the nation with Family Physicians.
Yes, if we love what we do and how we do it.  Quietly.

We are the Quiet Revolutionaries.

What do you think?

Wednesday, January 13, 2016

New Leap, New Year

New Leap, New Year

Click above for the Dr Synonymous Blogtalk Radio show about this subject.
Content includes:  Dr Jonas, your host, will do the usual blog, tweet and literature review with an eye toward the new year.  Healthcare is stuck.  What's going to deliver the course correction.  Will Family Medicine start a breakaway from business as usual? Will we move away from statin sluts and other business and bonus based dogmatists to connect with our patients and our duty to serve?
Can Direct Primary Care deliver on a promise of physician career satisfaction combined with patient satisfaction?

PTSD nightmares- treatment, Duration of PPI therapy for ulcers, Vitamin D therapy - not for everything. Medical bias against supplements and vitamins- my comments.  "Medical Marijuana" and "Why all the overuse of statins"? comments by Dr Jonas, your host.
Blogs by Kenny Lin, MD reviewed.

Dr Synonymous blog Review (3 posts): Medical Forgiveness
Hypermobile Patients
Direct Primary Care UnSummit IV in Columbus, OH February 20.

Wednesday, January 6, 2016

Direct Primary Care Ohio UnSummit IV in Columbus, OH Feb 20

Physicians in "Primary Care":  Do you want to live the dream of being the physician you intended to be?  Are you fed up with phony and/or misguided  initiatives that take you further and further from practicing medicine and helping your patients?  Do you want to have fun using your "physicianly" brain to help patients?  Does your career path suck?

Med Students:  Are you worried that primary care may be too overwhelming?  Do you want to be more aware of business models that impact medical practice?  Are you turned off by some of what you hear about the stressed out, frustrated and overwhelmed primary care physicians who are being "used by the system"?  Do you believe that medical practice can be fun?  And rewarding?

Nurse Practitioners and Physician Assistants in Primary Care:  Are you having enough fun?  Are you stressed, annoyed and fed up with artificial quotas and time limitations that prevent you from connecting with your patients?

You may want to check out Direct Primary Care, a business model that provides more freedom for frontline physicians, NP's and PA's in Family Medicine, General Internal Medicine, General Pediatrics and General Med/Peds.

Come to Columbus, Ohio on Saturday February 20 to find out if DPC might be for you.

Learn about:
DPC 101 What it is, What it does, Why it's important
DPC Nuts and Bolts:  How to do DPC
DPC Education:  How to Teach DPC
DPC Administration:  Office Setup for DPC- Pure and Hybrid
DPC for Hospitals (yes, we can even work together)
DPC Landscape- Nation and State
DPC Pitfalls and Challenges (OK, it's not perfect)

Not included:  CME credit.  Free lunch.  Anything about pricing of DPC or other numbers that might smell like illegal comments to the FTC.  The OAFP President-Elect doubles as the "Price Police" for the conference.

Presenters are national and state leaders in the "DPC Movement", including planners/speakers of the DPC National Summits I, II and III, the President-elect and a past President of the Ohio Academy of Family Physicians, an Osteopathic Resident Physician who is a member of the Board of the OAFP, etc.  (Not just superficially aware of DPC).  And we have Speakers with  experience in the top two DPC "Training" Companies.

More later.  Including price for the conference (All day:  $150 for physicians, NP's,PA's, Administrators, Legislators- $75 for residents, $25 for med students).  Extra person(s) from medical office reduced to $100 each.

Sponsored by the Center for Innovation in Family and Community Health (CIFCH) in Beavercreek with help from the Family Medicine Education Consortium, Inc. (FMEC)

Registration Form Here DPC Ohio UnSummit Flyer with Registration.  Checks to DPC Ohio UnSummit  CIFCH 2633 Commons Blvd, Suite 120 Beavercreek, OH 45431

Saturday, January 2, 2016

Physicians Let this be the Year of Medical Forgiveness: Doctor Forgive Yourself

OK, fellow physicians, let's accept that we're in collusion with the forces that are bankrupting America.  Let's look in the mirror and find a way, in our hearts, to forgive ourselves.


Let's become the spirit of the physician we imagined becoming in our letter of application to medical school (for those who wrote such a letter).  Let's open our hearts to the fun of being a physician again (or for the first time for many).

Let's humbly accept that we actually are as smart as is generally assumed and upgrade the profession to be a profession again.  With a code of ethics... that we honor and enforce, as expected by those we serve.

Let's seize, retain and exploit the initiative (and the surprise) to redirect health care to be health care again.  Not healthcare - an investment strategy and a way to help investors or governments play with money.

Let's love ourselves as if we actually are part of God's Creation.  Let's be the citizen of that Creation that we morally, ethically, humanly, spiritually can.

Forgive yourself, Fellow Physician.  One at a time and together.  Let's imagine who we are in a forgiven state and act on our freedom to be the physicians for the people we serve.

Family Medicine: Hypermobile Patients More Prevalent/ Pathology Than Expected

I am finding more hypermobile patients than would be expected for a practice like mine.  The chronic pain patients with spinal problems and sacroiliac pain are often responding positively to probing questions about Ehlers Danlos Syndrome.  "Are you double jointed?  Did you used to entertain your friends with contorting your body or stretching your skin?  Could you stand flatfooted with knees straight and put your palms flat on the floor?  Do your elbows and knees go "more than straight?"  Do your thumbs with wrists flexed touch the forearms?  Do your little fingers extend a good distance beyond 90 degrees?
This blog (click twice) has photos of what to look for and more for the Beighton Score and Brighton Criteria for assessing joint hypermobility and Ehlers Danlos Syndrome.

I have mentioned Ehlers Danlos Syndrome many times on my broadcasts (See the hyperlink to BlogTalk Radio to the right side of this post for the Dr. Synonymous Show).

These patients, known to have a flaw in the making of connective tissue such as collagen and/ or elastin, also have a tendency toward gastrointestinal problems with constipation, and are known to have as few bowel movements as once a week in them or their families.

A lot of them have chronic pain.  Many have other deficiencies such as methylation problems with their B Vitamins.

Inquiring about the joint issues in the Beighton Score with my patients on chronic pain medications yielded about two patients with hypermobility syndromes each week for five months.  A few with nagging spinal problems met the criteria.  Many have a long history of problems consistent with the Ehlers Danlos Syndrome diagnosis, while some have hypermobility but it never caused problems.  The latter group would be thought of as having "Benign Joint Hypermobility Syndrome".

Do you have a family of gymnasts, divers, cheerleaders who do back flips, skaters, etc.?

Long thought to affect one in 5,000 persons, the joint hypermobility syndrome(s) may be found in 1 in 500 persons or more.