Today I read a column on health screening tests that made me go "hmmm". To do or not to do? This is quite a controversial issue for patients and doctors. Many doctors fail to recommend screenings even if you are at risk for certain things. Screenings commonly occur after something has happened. Just because your doctor does not recommend a screening test does not mean you may not need it.
Screening colonoscopy tests and mammograms are recommended routinely for those without risk factors as well as for those with risk factors. Knowing when to get these tests may save your life. Why wait for symptoms to occur or for something medically devastating to happen? This is when it is usually paid for by your insurance. If a preventive screening test is not covered, or if your doctor does not recommend it may not be a reliable indicator.
When I think about the lives I have saved by medical preventive screening, I can positively say it is worth it. Yes, false positives and incidentalomas do occur with necessary as well as preventive testing. Abnormal findings may also be followed without unnecessary, risky surgeries or procedures depending on what is found. I have heard too many doctors express the unnecessary risks (especially with new tests) as a reason for not doing a test versus the benefit of finding something that can be "cured" with preventive screening. There should be more concern about early disease prevention and detection. I assure you that your doctors would do this for themselves. You deserve the best, too.
Educate yourself about medical prevention screening tests. Waiting for your doctor to recommend them or for your insurance to cover them may be hazardous to your health. Sometimes you may have to pay. Your car insurance does not cover car maintenance, but you pay to have auto checkups and for insurance. Why not do the same for your body? Paying a little now may save you and your money in the long term. After all, true wealth is great health.
miércoles, 28 de noviembre de 2007
Incidentaloma Update
It has been over one month since my thyroid ultrasound was performed. After two weeks I was still waiting to hear from my primary care doctor. I called the diagnostic testing center and the results were faxed to me within five minutes. I faxed copies to the endocrinology specialist that same day. I am still waiting to hear from both doctors about my abnormal test which appears to be consistent with a goiter.
Again, I must emphasize that one must not assume tests are normal when your doctors do not contact you. It is best for you to follow up for yourself.
Again, I must emphasize that one must not assume tests are normal when your doctors do not contact you. It is best for you to follow up for yourself.
viernes, 19 de octubre de 2007
Thyroid Incidentaloma
Incidentalomas are more common than we would like to think. They can be found most anywhere incidentally. As medical scanning tests have become more sophisticated, they have been able to detect more things. These incidental findings are known as incidentalomas. What do you do when a test your doctor has ordered detects an incidentaloma or multiple incidentalomas?
A thyroid nodule was innocently detected on a stress thallium heart test I had done four years ago. When I discussed this with my cardiologist, I was told no further testing was needed. Fortunately my primary care doctor felt otherwise (like I did) and ordered more tests. The thyroid uptake scan detected a cold nodule which can be consistent with cancer. An ultrasound guided needle biopsy was negative for cancer. My thyroid blood tests have remained normal over the years. In addition, the nodule cannot be seen or felt. Yearly sonograms have been stable and unchanged until this year.
I am waiting for the official report from my doctor for this year's sonogram done this week. The technician that did the ultrasound of the thyroid confirmed what I saw as I lay on the table and watched the screen. There were changes showing up. After four years of following this incidental finding, it turns out it is not so incidental.
Many physicians feel that incidentalomas should be left alone. There is much controversy over what to do about them because it is feared that unnecessary procedures, surgeries, and treatments may lead to increase morbidity and mortality. They are becoming more frequent as tests get better. As you can see ignoring them is far from the answer. It gave me a "free" ticket for a thyroid biopsy then kept showing up normal for a few years.
At least yearly surveillance is warranted for incidental findings. Depending on what is found, medical invasive intervention such as biopsy or surgery may be necessary. Additional testing as it relates to the incidentaloma is also indicated. Each person's case must be individualized. The more you know about it helps you and your doctors decide what is best for you.
It turns out that I found out about my incidentaloma incidentally - when I requested a copy of my stress test report.
by J.L. Richardson, M.D., family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.
www.mypatienthandbook.com
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd
A thyroid nodule was innocently detected on a stress thallium heart test I had done four years ago. When I discussed this with my cardiologist, I was told no further testing was needed. Fortunately my primary care doctor felt otherwise (like I did) and ordered more tests. The thyroid uptake scan detected a cold nodule which can be consistent with cancer. An ultrasound guided needle biopsy was negative for cancer. My thyroid blood tests have remained normal over the years. In addition, the nodule cannot be seen or felt. Yearly sonograms have been stable and unchanged until this year.
I am waiting for the official report from my doctor for this year's sonogram done this week. The technician that did the ultrasound of the thyroid confirmed what I saw as I lay on the table and watched the screen. There were changes showing up. After four years of following this incidental finding, it turns out it is not so incidental.
Many physicians feel that incidentalomas should be left alone. There is much controversy over what to do about them because it is feared that unnecessary procedures, surgeries, and treatments may lead to increase morbidity and mortality. They are becoming more frequent as tests get better. As you can see ignoring them is far from the answer. It gave me a "free" ticket for a thyroid biopsy then kept showing up normal for a few years.
At least yearly surveillance is warranted for incidental findings. Depending on what is found, medical invasive intervention such as biopsy or surgery may be necessary. Additional testing as it relates to the incidentaloma is also indicated. Each person's case must be individualized. The more you know about it helps you and your doctors decide what is best for you.
It turns out that I found out about my incidentaloma incidentally - when I requested a copy of my stress test report.
by J.L. Richardson, M.D., family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.
www.mypatienthandbook.com
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd
martes, 16 de octubre de 2007
Children's Medication Safety Alert
Our children's health and well being is so important. Last week cold drugs for children under two were being pulled off the counter for safety issues. What surprises me most about this is that the actual harmful ingredients have been unnamed "antihistamines and decongestants" with brand names. Many of these are combination of two or more medications.
One of the several brands recalled lists the actual name of the drug causing the deaths. All the brands should have the offending drugs listed. When parents know the actual medication, they can check other medicines they may still have in their medicine cabinet, and on the drugstore counter. Though a "voluntary" recall the New York Post states, "...some small companies may continue selling the product". Safety reviewers in the FDA "considered" the ban on this cold medication two weeks ago.
The reasoning behind this decision surprises me, also. They are safe when taken as directed , but "rare patterns of misuse" can lead to death. Misuse of just about anything will lead to an adverse outcome. Does that warrant removing the items in question? With almost a thousand products that fit this description (some maybe under other names not on the list), it should be known what the actual medication are that are causing the problem. My research on the Internet yielded the following.
For instance, Dimetapp contains Brompheniramine (the antihistamine) and pseudoephedrine (the decongestant). Active ingredients in Robitussin include dextromethorphan (cough suppressant) and guaifenisin (mucolytic). These are made by Wyeth. Clicking on the medicines at their respective websites, reveals the active ingredients. The press release on JNJ's (Johnson & Johnson) website leaves the ingredients out. The Tylenol website lists some of the Pediacare formulas' ingredients, and omits those for Tylenol products. Novartis manufactures Triaminic. The press release section at it's web site fails to mention the recall. Further navigation to Triaminic home page yields front page notification of the recall. Clicking on the product reveals the ingredients. Prestige Brands division, Medtech, makes the Little Colds line. The warning is found under "Investor Relations" in the press section of Prestige's home page. The product home page lists no warning, or product ingredients. Again, clicking on the medication informs you about phenylephrine and dextromethorphan. Pediacare, made by Johnson and Johnson, lists its active ingredients as phenylephrine and pseudoepedrine in 4 of its 5 products on the CHPA, Consumer Healthcare Products Association, website (www.otcsafety.org). This organization represents the country's over the counter drug manufacturers and distributors. CHPA voiced its initial concern in a press release 8/16/07, and the voluntary recall was 10/11/07. That is almost two months ago.
The FDA meets this week with "outside" experts to decide if a ban or "voluntary" recall is necessary. In the meantime, parents are responsible for making sure that the 14 products listed are not used in children under two. They must also check other medication not on the list. It appears that pseudoephedrine, phenylephrine, and brompheniramine are the drugs causing the problems. Pseudoepedrine for adults went from over the counter to a "sign for" medication last year.
The websites of the drug manufacturers shows the medications being recalled; however, the actual ingredients in the medication were likely to be missing. It was rather inconsistent. Other drugs, with the ingredients, and some of the listed drugs advised for this age group were still listed here, and for sale on the web. It was somewhat reassuring to see that the companies gave phone numbers to contact for further information.
Hopefully, the FDA meeting will clarify the issue this week. Maybe you will see a press release that lists the drug ingredients, and more readily visibility on the web pages as well as television screens. TV stations now tend to pass this information off these days by telling you to check their website instead of listing it on TV (like they used to do). Everyone does not have access to the Internet. For our children, give us some type of continuity in reporting this type of information across the news wires. The biggest task is to get accurate, detailed information to every parent's mailbox in a timely manner.
by J.L. Richardson. MD, family medicine doctor, patient advocate, and author of Patient Handbook to Medical Care; Your Personal Health Guide, a Writer's Digest 14th International Self-Published Book Award winner in reference books.
http://www.mypatienthandbook.com/
www.blogtalkradio.com/drjfpmd
www.twitter.com/MD4U
Actual book excerpts on Google Books http://dld.bz/bZ39
One of the several brands recalled lists the actual name of the drug causing the deaths. All the brands should have the offending drugs listed. When parents know the actual medication, they can check other medicines they may still have in their medicine cabinet, and on the drugstore counter. Though a "voluntary" recall the New York Post states, "...some small companies may continue selling the product". Safety reviewers in the FDA "considered" the ban on this cold medication two weeks ago.
The reasoning behind this decision surprises me, also. They are safe when taken as directed , but "rare patterns of misuse" can lead to death. Misuse of just about anything will lead to an adverse outcome. Does that warrant removing the items in question? With almost a thousand products that fit this description (some maybe under other names not on the list), it should be known what the actual medication are that are causing the problem. My research on the Internet yielded the following.
For instance, Dimetapp contains Brompheniramine (the antihistamine) and pseudoephedrine (the decongestant). Active ingredients in Robitussin include dextromethorphan (cough suppressant) and guaifenisin (mucolytic). These are made by Wyeth. Clicking on the medicines at their respective websites, reveals the active ingredients. The press release on JNJ's (Johnson & Johnson) website leaves the ingredients out. The Tylenol website lists some of the Pediacare formulas' ingredients, and omits those for Tylenol products. Novartis manufactures Triaminic. The press release section at it's web site fails to mention the recall. Further navigation to Triaminic home page yields front page notification of the recall. Clicking on the product reveals the ingredients. Prestige Brands division, Medtech, makes the Little Colds line. The warning is found under "Investor Relations" in the press section of Prestige's home page. The product home page lists no warning, or product ingredients. Again, clicking on the medication informs you about phenylephrine and dextromethorphan. Pediacare, made by Johnson and Johnson, lists its active ingredients as phenylephrine and pseudoepedrine in 4 of its 5 products on the CHPA, Consumer Healthcare Products Association, website (www.otcsafety.org). This organization represents the country's over the counter drug manufacturers and distributors. CHPA voiced its initial concern in a press release 8/16/07, and the voluntary recall was 10/11/07. That is almost two months ago.
The FDA meets this week with "outside" experts to decide if a ban or "voluntary" recall is necessary. In the meantime, parents are responsible for making sure that the 14 products listed are not used in children under two. They must also check other medication not on the list. It appears that pseudoephedrine, phenylephrine, and brompheniramine are the drugs causing the problems. Pseudoepedrine for adults went from over the counter to a "sign for" medication last year.
The websites of the drug manufacturers shows the medications being recalled; however, the actual ingredients in the medication were likely to be missing. It was rather inconsistent. Other drugs, with the ingredients, and some of the listed drugs advised for this age group were still listed here, and for sale on the web. It was somewhat reassuring to see that the companies gave phone numbers to contact for further information.
Hopefully, the FDA meeting will clarify the issue this week. Maybe you will see a press release that lists the drug ingredients, and more readily visibility on the web pages as well as television screens. TV stations now tend to pass this information off these days by telling you to check their website instead of listing it on TV (like they used to do). Everyone does not have access to the Internet. For our children, give us some type of continuity in reporting this type of information across the news wires. The biggest task is to get accurate, detailed information to every parent's mailbox in a timely manner.
by J.L. Richardson. MD, family medicine doctor, patient advocate, and author of Patient Handbook to Medical Care; Your Personal Health Guide, a Writer's Digest 14th International Self-Published Book Award winner in reference books.
http://www.mypatienthandbook.com/
www.blogtalkradio.com/drjfpmd
www.twitter.com/MD4U
Actual book excerpts on Google Books http://dld.bz/bZ39
miércoles, 3 de octubre de 2007
Inflated Insurance Premiums
In response to the most recent 11% increase in my health insurance premium, I say please tell me how to decrease this humongous, hefty payment. After about seven years of stable prices and reasonable increases that were not higher than the average 3% cost of living per year, the last four years have been double digit increases.
My premium has gone from one of my smallest monthly bills, not even in the top ten, to the second. It follows my monthly mortgage (and interest, homeowners insurance, and windstorm
insurance in one bill). There is also flood and auto insurance. Together with the other home insurance protection mentioned, the total is about half of what my yearly health insurance will be. It used to be the other way around.
What is one to do? My initial thought was...well, my second and third thoughts were to call and write the insurance company, and to see what else I could trim from the monthly budget. My hundred dollar medication (not covered by insurance)? My weekly physical therapy treatment (not covered by insurance, but prescribed by my doctor)? My visits to the doctor? My grocery bill? My gas for the car? My windstorm (if you have a mortgage they say this can't be done),homeowners, and flood insurances? Postpone my new roof or keep the leaky one? At least I will get a discount on my windstorm and homeowners insurance premium for a new roof because of the preventive hurricane code application. For all the medical prevention I have done, it seems as if my insurance company could follow suit. I have saved them a lot of money, and continue to do so.
Well, I am considering all options. I wrote a letter to my insurance company via email last week. I am still waiting for a reply. I will call them if there is no response by tomorrow. Sometimes calling and getting a response can take just as long.
It makes me wonder what other patients are doing in response to increasing inflated insurance premiums. What price is too much for your most important asset - YOU?
My premium has gone from one of my smallest monthly bills, not even in the top ten, to the second. It follows my monthly mortgage (and interest, homeowners insurance, and windstorm
insurance in one bill). There is also flood and auto insurance. Together with the other home insurance protection mentioned, the total is about half of what my yearly health insurance will be. It used to be the other way around.
What is one to do? My initial thought was...well, my second and third thoughts were to call and write the insurance company, and to see what else I could trim from the monthly budget. My hundred dollar medication (not covered by insurance)? My weekly physical therapy treatment (not covered by insurance, but prescribed by my doctor)? My visits to the doctor? My grocery bill? My gas for the car? My windstorm (if you have a mortgage they say this can't be done),homeowners, and flood insurances? Postpone my new roof or keep the leaky one? At least I will get a discount on my windstorm and homeowners insurance premium for a new roof because of the preventive hurricane code application. For all the medical prevention I have done, it seems as if my insurance company could follow suit. I have saved them a lot of money, and continue to do so.
Well, I am considering all options. I wrote a letter to my insurance company via email last week. I am still waiting for a reply. I will call them if there is no response by tomorrow. Sometimes calling and getting a response can take just as long.
It makes me wonder what other patients are doing in response to increasing inflated insurance premiums. What price is too much for your most important asset - YOU?
viernes, 14 de septiembre de 2007
DOCTOR, MAY I? GETTING PERMISSION TO SEE THE DOCTORS YOU WANT TO SEE
How would you feel if you were not able to call a doctor that you want to see and make an appointment for yourself or a loved one? If you think about this happening somewhere overseas, it may be, but it’s happening here, too. In fact you would probably have more success booking an operation abroad yourself than you would a doctor appointment here.
I had not even fathomed such a thing could ever occur. Last year I called and scheduled an appointment with a specialist I wanted to see. I did not have to contact a doctor, namely the gate keeping primary care physician, to make this possible. Nor did I have to “get permission” to get an appointment for my body scan. My HMO does not pay for some providers I seek, but I am able to make appointments that I think are best for me.
I found out something new today as I was scheduling appointments for my father. I called doctors that he wanted to see and some new ones. Some of his current doctors have lost (if they ever had any) common courtesy and kindness, plus they were below par to him. So he wanted to change to doctors with courtesy, kindness and expertise. Of the four doctor’s offices I called this Friday afternoon, only one allowed me to make an appointment for him without another doctor’s referral. Hmm...doctors accepting patients referred by doctors only.
This practice of “doctor referrals only” seems quite unethical and unhealthy and untimely for patients. I am at a loss for words. I’ll have to write more about this later. Doctor, may I?
I had not even fathomed such a thing could ever occur. Last year I called and scheduled an appointment with a specialist I wanted to see. I did not have to contact a doctor, namely the gate keeping primary care physician, to make this possible. Nor did I have to “get permission” to get an appointment for my body scan. My HMO does not pay for some providers I seek, but I am able to make appointments that I think are best for me.
I found out something new today as I was scheduling appointments for my father. I called doctors that he wanted to see and some new ones. Some of his current doctors have lost (if they ever had any) common courtesy and kindness, plus they were below par to him. So he wanted to change to doctors with courtesy, kindness and expertise. Of the four doctor’s offices I called this Friday afternoon, only one allowed me to make an appointment for him without another doctor’s referral. Hmm...doctors accepting patients referred by doctors only.
This practice of “doctor referrals only” seems quite unethical and unhealthy and untimely for patients. I am at a loss for words. I’ll have to write more about this later. Doctor, may I?
miércoles, 29 de agosto de 2007
BRAVO DR. OZ
BRAVO TO DR. OZ! ON TODAY'S OPRAH SHOW HIS MEDICAL REPORTS SHOWED US WHO WE REALLY ARE IN TIMES OF DISASTER AND TWO YEARS AFTERWARD. MEDICAL RESOURCES ARE LIMITED, ALMOST EXTINCT IN POST-DISASTER AREAS. ONE OF THE MOST IMPORTANT POINTS HE MADE WAS THE FACT THAT NO ONE IS IMMUNE.
MICHAEL MOORE'S FILM SICKO SHOWED US WHO WE REALLY ARE IN EVERY DAY LIFE. IT IS A VERY THIN LINE. SO THIN THAT IT IS NOT NUMBER ONE ON ANY PRESIDENTIAL CANDIDATE'S LIST. THE HEALTH OF A NATION DEPENDS ON THE HEALTH OF ALL OF ITS PEOPLE.
WE CAN HOPE MEDICAL CARE GETS BETTER, BUT AS ANDERSON COOPER SAID, HOPE IS NOT A PLAN.
THANKS AGAIN, OPRAH.
MICHAEL MOORE'S FILM SICKO SHOWED US WHO WE REALLY ARE IN EVERY DAY LIFE. IT IS A VERY THIN LINE. SO THIN THAT IT IS NOT NUMBER ONE ON ANY PRESIDENTIAL CANDIDATE'S LIST. THE HEALTH OF A NATION DEPENDS ON THE HEALTH OF ALL OF ITS PEOPLE.
WE CAN HOPE MEDICAL CARE GETS BETTER, BUT AS ANDERSON COOPER SAID, HOPE IS NOT A PLAN.
THANKS AGAIN, OPRAH.
miércoles, 22 de agosto de 2007
SUMMER VACATION - MEDICAL MECCA
I am back from summer vacation. Instead it turned out to be my distant and unexpected family medical mecca. Now it is time to catch up on my medical maladies - five specialist appointments to make! I had seen my primary care doctor (PCD) a few weeks prior to my presumed vacation. Since I had not heard anything from him, I figured all my test results were okay. I would check and get copies when I got back from summer vacation with the folks.
I had received referrals for all my routine medical tests and doctor visits before leaving. I would reschedule any that were scheduled during the time I was away. This turned out to be all of them. I had requested appointment times for late July.
Upon return I busied myself with my medical agenda. First, I called my PCD to discuss endocrine specialist appointment. It seems that the referral for this, the most important, is absent! It addresses abnormal test findings that have given no symptoms that I am aware are happening.
The endocrine appointment is important because it address several medical maladies that may be giving clues to other conditions. It all started with my first full body scan 6 years ago. Several abnormalities were found. All have proven benign except for the huge kidney stone blocking the inside of my kidney. It had caused no symptoms! It is the benign tumor that now may be stirring things up. It was an incidental finding. In medical terms this is called an "incidentaloma". The scary thing is that another incidentaloma in a different organ was detected during a routine heart stress test a couple of years ago!
What do you do when you have two supposedly benign incidental tumors noted on two different organs in your body? Of course you want to have it all checked out and probably taken out!
As medical tests become more sophisticated and pick up more things, we are faced with a surplus of incidentalomas. The medical profession is in a quandary as well. Often times the procedures, which may entail surgery, to check these out are risky and life threatening. Then again, the incidental finding may be as well. Or it may be incidental. This is where comprehensive testing and routine follow up are important.
For the next few weeks, join me on this blog journey to incidentolomas.
I had received referrals for all my routine medical tests and doctor visits before leaving. I would reschedule any that were scheduled during the time I was away. This turned out to be all of them. I had requested appointment times for late July.
Upon return I busied myself with my medical agenda. First, I called my PCD to discuss endocrine specialist appointment. It seems that the referral for this, the most important, is absent! It addresses abnormal test findings that have given no symptoms that I am aware are happening.
The endocrine appointment is important because it address several medical maladies that may be giving clues to other conditions. It all started with my first full body scan 6 years ago. Several abnormalities were found. All have proven benign except for the huge kidney stone blocking the inside of my kidney. It had caused no symptoms! It is the benign tumor that now may be stirring things up. It was an incidental finding. In medical terms this is called an "incidentaloma". The scary thing is that another incidentaloma in a different organ was detected during a routine heart stress test a couple of years ago!
What do you do when you have two supposedly benign incidental tumors noted on two different organs in your body? Of course you want to have it all checked out and probably taken out!
As medical tests become more sophisticated and pick up more things, we are faced with a surplus of incidentalomas. The medical profession is in a quandary as well. Often times the procedures, which may entail surgery, to check these out are risky and life threatening. Then again, the incidental finding may be as well. Or it may be incidental. This is where comprehensive testing and routine follow up are important.
For the next few weeks, join me on this blog journey to incidentolomas.
viernes, 22 de junio de 2007
MEDICATION INFORMATION
Should patients receive the same information about medication that doctors get? YES!
The information that comes with the medication should be given to the patient. After all the patient is the one taking the medicine. The benefits and the risks should be readily available; however, this is very seldom the case. Most of the time the doctor has not read this information, and does not give it to the patient. There is usually a lot to read. There is so much to read that most drug companies use extremely small print on a few pages to tell about the drug. How many doctors or pharmacists even get to the last page of "patient counseling information"? If there is specific patient information, why is it at the end? Why is there information "for doctors only"? Why is the patient information so different from the doctor information?
Medication errors occur far too frequently to leave the patient out. Medication awareness for patients should be as important as diagnosis and treatment. Full disclosure of the good, bad and ugly effects of medication should be available to anyone who wants to know about it - especially the one taking it.
The information that comes with the medication should be given to the patient. After all the patient is the one taking the medicine. The benefits and the risks should be readily available; however, this is very seldom the case. Most of the time the doctor has not read this information, and does not give it to the patient. There is usually a lot to read. There is so much to read that most drug companies use extremely small print on a few pages to tell about the drug. How many doctors or pharmacists even get to the last page of "patient counseling information"? If there is specific patient information, why is it at the end? Why is there information "for doctors only"? Why is the patient information so different from the doctor information?
Medication errors occur far too frequently to leave the patient out. Medication awareness for patients should be as important as diagnosis and treatment. Full disclosure of the good, bad and ugly effects of medication should be available to anyone who wants to know about it - especially the one taking it.
lunes, 18 de junio de 2007
MEDICATION AWARENESS MONTH
We are mid way through Medication Awareness Month. Have you checked your medicines? See the blog for June 5th for details.
A word to medication producers...please improve packaging of medication. Blister packs are nice, convenient but can be difficult to open especially for arthritic hands.
A word to medication producers...please improve packaging of medication. Blister packs are nice, convenient but can be difficult to open especially for arthritic hands.
domingo, 10 de junio de 2007
EMAIL TO OPRAH
MS. WINFREY,
WWW.CODEBLUENOW.ORG. AMERICAN HEALTH CARE NEEDS ADVANCED, INTENSIVE RESUSCITATION.
YOUR INTERVIEW WITH MICHAEL MOORE AND HIS MOVIE "SICKO" REVEALED HOW "SICKO" AMERICAN HEALTH CARE REALLY IS. IT IS GOOD TO HEAR YOU BOTH SPEAK ABOUT JOINING EFFORTS IN A BIPARTISAN WAY WITH THE PEOPLE.
IN THE DEBATES, THE PRESIDENTIAL CANDIDATES BARELY MENTIONED THE HEALTH CARE MALIGNANCY METASTASIZING THROUGHOUT THE HEALTH SYSTEM. SO SAD. MAYBE 2 MINUTES TOPS BETWEEN BOTH SIDES.
THANKS FOR DR. OZ! WE NEED MORE LIKE HIM.
BLESSINGS,
J RICHARDSON MD
WWW.CODEBLUENOW.ORG. AMERICAN HEALTH CARE NEEDS ADVANCED, INTENSIVE RESUSCITATION.
YOUR INTERVIEW WITH MICHAEL MOORE AND HIS MOVIE "SICKO" REVEALED HOW "SICKO" AMERICAN HEALTH CARE REALLY IS. IT IS GOOD TO HEAR YOU BOTH SPEAK ABOUT JOINING EFFORTS IN A BIPARTISAN WAY WITH THE PEOPLE.
IN THE DEBATES, THE PRESIDENTIAL CANDIDATES BARELY MENTIONED THE HEALTH CARE MALIGNANCY METASTASIZING THROUGHOUT THE HEALTH SYSTEM. SO SAD. MAYBE 2 MINUTES TOPS BETWEEN BOTH SIDES.
THANKS FOR DR. OZ! WE NEED MORE LIKE HIM.
BLESSINGS,
J RICHARDSON MD
jueves, 7 de junio de 2007
COMMUNICATION GAP
Look how long it took health officials to find a man with infectious extreme drug resistant (XDR) tuberculosis (TB) after “talking” with him about his condition. Did they tell him that he was and that he could not travel? In the taped (taped by his father) conversation with the doctor, the doctor said, “There is no reason for you to be sequestered”. The letter telling him he was infectious and not to travel arrived after he left the country. Did anyone try to call him, email him, text him or his immediate family?
Communication and comprehension are not the only issues here. Look how long it took to get to this point. The gentleman was alerted that he may have a severe form of TB back in April. It is now June. There is some hesitancy here. He was initially diagnosed, according to his TV interview with “The King”, Larry King, that he was diagnosed with TB over a year ago. Treatment until May had been stable, uneventful. Now he faces long term treatment, and possibly part of his lung may have to be removed.
Communication is the number one item that patients say hinder their health care. They rarely get to tell their whole story before the doctor interrupts. It gets to a point where you don’t understand what your health providers are saying, and you just do what you think they told you. Or do you?
If the “big dogs” like the CDC and health departments have problems in talking to patients so that they understand, where does that leave the rest of us?
Communication is the fifth vital sign (the others are blood pressure, temperature, pulse rate, respirations). Understanding what is said is part of this. Talk much. Listen more. Ask to repeat. Ask questions. Write it down. Or tape it.
Communication and comprehension are not the only issues here. Look how long it took to get to this point. The gentleman was alerted that he may have a severe form of TB back in April. It is now June. There is some hesitancy here. He was initially diagnosed, according to his TV interview with “The King”, Larry King, that he was diagnosed with TB over a year ago. Treatment until May had been stable, uneventful. Now he faces long term treatment, and possibly part of his lung may have to be removed.
Communication is the number one item that patients say hinder their health care. They rarely get to tell their whole story before the doctor interrupts. It gets to a point where you don’t understand what your health providers are saying, and you just do what you think they told you. Or do you?
If the “big dogs” like the CDC and health departments have problems in talking to patients so that they understand, where does that leave the rest of us?
Communication is the fifth vital sign (the others are blood pressure, temperature, pulse rate, respirations). Understanding what is said is part of this. Talk much. Listen more. Ask to repeat. Ask questions. Write it down. Or tape it.
martes, 5 de junio de 2007
MEDICATION AWARENESS MONTH
June is officially declared Medication Awareness Month(MAM).
Check ALL the medication you take. This includes prescription,non-prescription/ over the counter, herbals, supplements, vitamins, foods with supplements (like calcium milligrams in a cup of juice). This is important as you may be taking a calcium supplement and/ or Tums. That could add up to more calcium than is recommended. One risk of too much calcium is a kidney stone.
Check the medication expiration dates. Throw out the expired ones.
Keep medication in a safe place. This means out of the reach of children, and adults that are unable to administer their own medicine.
When starting a new medication, be sure you have read up on it. Ask your doctor about it. Since medication side effect lists tend to be quite lengthy, many doctors do not have the time to discuss them with you. Be sure to get a copy and read it yourself. Ask your doctor or pharmacist as well as looking it up in the library or on the Internet. Call the company that makes the medicine.
This is just a few things to consider with taking medication. Later in the blog, pharmacy expert Ronald Kaler will discuss more medication awareness tips.
Check ALL the medication you take. This includes prescription,non-prescription/ over the counter, herbals, supplements, vitamins, foods with supplements (like calcium milligrams in a cup of juice). This is important as you may be taking a calcium supplement and/ or Tums. That could add up to more calcium than is recommended. One risk of too much calcium is a kidney stone.
Check the medication expiration dates. Throw out the expired ones.
Keep medication in a safe place. This means out of the reach of children, and adults that are unable to administer their own medicine.
When starting a new medication, be sure you have read up on it. Ask your doctor about it. Since medication side effect lists tend to be quite lengthy, many doctors do not have the time to discuss them with you. Be sure to get a copy and read it yourself. Ask your doctor or pharmacist as well as looking it up in the library or on the Internet. Call the company that makes the medicine.
This is just a few things to consider with taking medication. Later in the blog, pharmacy expert Ronald Kaler will discuss more medication awareness tips.
VOTE FOR HEALTHCARE
Sunday's Democratic presidential debate revealed little about the health care crisis in America. The candidates seem to focus on issues important to them while commenting on the present president's actions quite contrarily. The war in Iraq took precedence over all followed by Iraq's weaponization and terrorism. Immigration was discussed. Many homeland issues were briefly touched on, but not emphasized.
Where is the love for the people of America? Shouldn't more attention be focused on health care, jobs, wages, housing, homeland security, etc? The issues discussed during the debate missed the mark. There must be more focus on the American people!
Great health is true wealth. It should be a primary concern for our next president. To keep our nation wealthy, we must be healthy. For the record, one candidate, Governor Bill Richardson, had responses for many of the health care concerns America faces.
This is evident on his website. There was a report entitled "The Candidates Side-by-side on Health Care". Many issues were left blank by the other candidates. Governor Richardson left no blank spaces. He has an "innovative national health care plan" (as does Senator Obama, 15 pages while Senator Kucinich lists a universal health care plan as the top issue). The other candidates had a page or two on health care.
As election time draws closer, hopefully health issues will be number one on every one's list. Great health, true wealth?
Where is the love for the people of America? Shouldn't more attention be focused on health care, jobs, wages, housing, homeland security, etc? The issues discussed during the debate missed the mark. There must be more focus on the American people!
Great health is true wealth. It should be a primary concern for our next president. To keep our nation wealthy, we must be healthy. For the record, one candidate, Governor Bill Richardson, had responses for many of the health care concerns America faces.
This is evident on his website. There was a report entitled "The Candidates Side-by-side on Health Care". Many issues were left blank by the other candidates. Governor Richardson left no blank spaces. He has an "innovative national health care plan" (as does Senator Obama, 15 pages while Senator Kucinich lists a universal health care plan as the top issue). The other candidates had a page or two on health care.
As election time draws closer, hopefully health issues will be number one on every one's list. Great health, true wealth?
jueves, 31 de mayo de 2007
DEAF HEALTH CARE
Today I ran into a 43 year old gentleman at a local place of business. He asked me for money for food. I started talking to him and saw that he was reading my lips. He read lips very well. He failed to understand sign language. We were able to communicate enough to exchange names, and find that he was deaf from an early age possibly from birth. He was unsure. He was looking for work. We discussed how it is hard for many deaf people to get jobs because they are deaf. I tipped him for his pleasant conversation and recognized the sadness of it all.
After this encounter with fate, I reflected on yet another deaf person that had been failed by the American health system. How this system is able to allow a hearing impaired young man get well into adulthood without proper medical attention to assist with his deafness. He should know how to sign. He should have money. He should have work. He should have health care. He should have been covered since birth.
I know this scenario all to well. I have a brother who was born deaf. The system is still failing him all around, too. He and his deaf spouse both work yet their combined salaries are at “poverty level”. Rather than the system continuing all assistance beyond 18 years of age, they encourage working versus working plus government assistance. How does the government expect him to pay money he supposedly owes them over a 10-year debt? Does he really owe them? Without steady employment and government assistance, it is impossible. Each time he applies for government help like Medicaid, Social Security Disability Income, etc., he is cast aside with uncertainty. It is truly devastating to the human spirit.
He struggles on with a part-time job at minimum wage with no benefits. I have helped him find the medical care he needs. It is a family affair. Many of his doctors give generous discounts when he “tells” them he is uninsured. This has really helped him get the medical care he needs. Over the years I have collected his records and taught him to work his way through the medical system.
His medical record is his basic communication tool along with reading lips, and writing things down. He is a master at sign language (and so many things), but none of his doctors know sign language. He requires an interpreter, but it is difficult to arrange when you are deaf and no one knows your language or how to use the TDD (telecommunication device for the deaf) phone devices or operator services. You can even do it on line. How do you get a doctor appointment? Often the emergency room becomes the primary care clinic.
If you are not heard, you are ignored or misunderstood. We must open our ears to the deaf and all people with disabilities. To be born deaf is not ever hearing anything. It makes us realize the importance of communication, another vital sign.
After this encounter with fate, I reflected on yet another deaf person that had been failed by the American health system. How this system is able to allow a hearing impaired young man get well into adulthood without proper medical attention to assist with his deafness. He should know how to sign. He should have money. He should have work. He should have health care. He should have been covered since birth.
I know this scenario all to well. I have a brother who was born deaf. The system is still failing him all around, too. He and his deaf spouse both work yet their combined salaries are at “poverty level”. Rather than the system continuing all assistance beyond 18 years of age, they encourage working versus working plus government assistance. How does the government expect him to pay money he supposedly owes them over a 10-year debt? Does he really owe them? Without steady employment and government assistance, it is impossible. Each time he applies for government help like Medicaid, Social Security Disability Income, etc., he is cast aside with uncertainty. It is truly devastating to the human spirit.
He struggles on with a part-time job at minimum wage with no benefits. I have helped him find the medical care he needs. It is a family affair. Many of his doctors give generous discounts when he “tells” them he is uninsured. This has really helped him get the medical care he needs. Over the years I have collected his records and taught him to work his way through the medical system.
His medical record is his basic communication tool along with reading lips, and writing things down. He is a master at sign language (and so many things), but none of his doctors know sign language. He requires an interpreter, but it is difficult to arrange when you are deaf and no one knows your language or how to use the TDD (telecommunication device for the deaf) phone devices or operator services. You can even do it on line. How do you get a doctor appointment? Often the emergency room becomes the primary care clinic.
If you are not heard, you are ignored or misunderstood. We must open our ears to the deaf and all people with disabilities. To be born deaf is not ever hearing anything. It makes us realize the importance of communication, another vital sign.
sábado, 26 de mayo de 2007
QUALITY WEBSITE
AHRQ.GOV
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
“GIVE INFORMATION. GET INFORMATION.”
- “QUESTIONS ARE ANSWER” SECTION THAT EMPHASIZES ASKING QUESTIONS, ESPECIALLY THE
RIGHT QUESTIONS – VERY THOROUGH! WWW.AHRQ.GOV/QUESTIONSARETHEANSWER
- HELPS PATIENTS BUILD QUESTION LIST (PLUS YOU CAN ENLARGE THE TEXT!) – EXCELLENT!
PATIENTS CAN CREATE THE LIST AND PRINT IT OUT!
- TELLS YOU TO TAKE NOTES AT DOCTOR VISITS! BRING YOUR NOTES IN, TOO.
- TOPICS INCLUDE – TALKING TO YOUR DOCTOR, GETTING MEDICAL TESTS, GETTING A
PRESCRIPTION, PLANNING FOR SURGERY, REDUCING MEDICAL MISTAKES
- CLICK ON SECTION "CONSUMERS AND PATIENTS" FOR BASIC HEALTH INFORMATION FOCUSING ON
WELLNESS AND PREVENTION, QUALITY OF CARE, HEALTH PLANS
- AHRQ AND USPSTF HAS A GREAT GUIDE CALLED “CLINICAL PREVENTION GUIDELINES”
- ORDERED ON LINE AND RECEIVED IT IN ABOUT ONE WEEK - YOU CAN ALSO DOWNLOAD IT
- OTHER GUIDES AT THEIR SITE FOR HEALTHY WOMEN AND HEALTHY MEN, ETC.
- SEE HOW "AHRQ HELPS PEOPLE" AT WWW.AHRQ.GOV/NEWS/FOCUS/INDEX.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
“GIVE INFORMATION. GET INFORMATION.”
- “QUESTIONS ARE ANSWER” SECTION THAT EMPHASIZES ASKING QUESTIONS, ESPECIALLY THE
RIGHT QUESTIONS – VERY THOROUGH! WWW.AHRQ.GOV/QUESTIONSARETHEANSWER
- HELPS PATIENTS BUILD QUESTION LIST (PLUS YOU CAN ENLARGE THE TEXT!) – EXCELLENT!
PATIENTS CAN CREATE THE LIST AND PRINT IT OUT!
- TELLS YOU TO TAKE NOTES AT DOCTOR VISITS! BRING YOUR NOTES IN, TOO.
- TOPICS INCLUDE – TALKING TO YOUR DOCTOR, GETTING MEDICAL TESTS, GETTING A
PRESCRIPTION, PLANNING FOR SURGERY, REDUCING MEDICAL MISTAKES
- CLICK ON SECTION "CONSUMERS AND PATIENTS" FOR BASIC HEALTH INFORMATION FOCUSING ON
WELLNESS AND PREVENTION, QUALITY OF CARE, HEALTH PLANS
- AHRQ AND USPSTF HAS A GREAT GUIDE CALLED “CLINICAL PREVENTION GUIDELINES”
- ORDERED ON LINE AND RECEIVED IT IN ABOUT ONE WEEK - YOU CAN ALSO DOWNLOAD IT
- OTHER GUIDES AT THEIR SITE FOR HEALTHY WOMEN AND HEALTHY MEN, ETC.
- SEE HOW "AHRQ HELPS PEOPLE" AT WWW.AHRQ.GOV/NEWS/FOCUS/INDEX.
jueves, 24 de mayo de 2007
DRUG DECEPTION BY OMISSION
The new drug Lybrel has been approved for contraception and menstrual period suppression in females. Every news release has been “praising” this drug that stops women from naturally menstruating. Why would anyone want to do this? Will it be targeted to our teenage women of tomorrow who are too busy for a period? How will it react with the mandatory HPV vaccine?
Out of all the reading I did, I failed to come up with concrete information on the side effects in any news articles. There was one statement, “The Lybrel safety and efficacy study was published in the December 2006 issue of the journal Contraception”. This study was supported by a grant from the drug maker. How many patients have access to this? Will the prescribing doctor have the information to pass along?
Finally at www.ocregister.com (Orange County California newspaper) there was this:
"Side effects: Irregular menstrual bleeding. Rare side effects of Lybrel included gallbladder inflammation, blood clots in deep veins, ectopic pregnancy, prolonged vaginal bleeding and enlarged uterine fibroids. There's concern over whether women might irreversibly lose bone density when periods are suppressed for a long time."
The drug manufacturer’s website has a 25 page insert that should come with the prescription called “Information for the Patient – Brief Summary Package Insert”. It states that “the symptoms associated with these serious side effects are discussed in the detailed leaflet given to you with your supply of pills”. There is a section, detailed patient labeling, that cites more side effects and risks. How many patients will receive this from their doctor who has access to 48 pages of "prescribing information"? The prescribing information has 15 pages that include adverse reactions not mentioned in the patient insert. There are also warnings, a black box warning, and precautions. The "brief summary patient package insert" is included in the prescribing information.
Clinical trials revealed that the pill was effective completely in 59% while 41% had breakthrough bleeding. So there is a 41% chance that the patient taking this medication may not get the intended results - continue bleeding and get pregnant. The patient may not realize that she is pregnant, and still be taking the drug. There is a warning about this possibly occurring with this “contraceptive stop-your-period pill”.
Does this make sense? Drug deception by omission – is it okay?
The insert closes with the following statement:
"If you want more information about birth-control pills, ask your health care professional or pharmacist. They have a more technical leaflet called the Professional Labeling which you may wish to read. This product’s label may have been updated. For current package insert and further product information, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556."
Be sure to get a copy of the drug insert and prescribing information that comes with the medication from your doctor and/or pharmacist. Get out a magnifying glass to read the tiny print, and a medical dictionary to look up the medical terms. Look it up on the Internet at the drug manufacturer's website for easier reading and more details.
Out of all the reading I did, I failed to come up with concrete information on the side effects in any news articles. There was one statement, “The Lybrel safety and efficacy study was published in the December 2006 issue of the journal Contraception”. This study was supported by a grant from the drug maker. How many patients have access to this? Will the prescribing doctor have the information to pass along?
Finally at www.ocregister.com (Orange County California newspaper) there was this:
"Side effects: Irregular menstrual bleeding. Rare side effects of Lybrel included gallbladder inflammation, blood clots in deep veins, ectopic pregnancy, prolonged vaginal bleeding and enlarged uterine fibroids. There's concern over whether women might irreversibly lose bone density when periods are suppressed for a long time."
The drug manufacturer’s website has a 25 page insert that should come with the prescription called “Information for the Patient – Brief Summary Package Insert”. It states that “the symptoms associated with these serious side effects are discussed in the detailed leaflet given to you with your supply of pills”. There is a section, detailed patient labeling, that cites more side effects and risks. How many patients will receive this from their doctor who has access to 48 pages of "prescribing information"? The prescribing information has 15 pages that include adverse reactions not mentioned in the patient insert. There are also warnings, a black box warning, and precautions. The "brief summary patient package insert" is included in the prescribing information.
Clinical trials revealed that the pill was effective completely in 59% while 41% had breakthrough bleeding. So there is a 41% chance that the patient taking this medication may not get the intended results - continue bleeding and get pregnant. The patient may not realize that she is pregnant, and still be taking the drug. There is a warning about this possibly occurring with this “contraceptive stop-your-period pill”.
Does this make sense? Drug deception by omission – is it okay?
The insert closes with the following statement:
"If you want more information about birth-control pills, ask your health care professional or pharmacist. They have a more technical leaflet called the Professional Labeling which you may wish to read. This product’s label may have been updated. For current package insert and further product information, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556."
Be sure to get a copy of the drug insert and prescribing information that comes with the medication from your doctor and/or pharmacist. Get out a magnifying glass to read the tiny print, and a medical dictionary to look up the medical terms. Look it up on the Internet at the drug manufacturer's website for easier reading and more details.
lunes, 21 de mayo de 2007
IDEAL HEALTH SYSTEM
For the ideal American health system, the goal must be provision of health care to everyone. This is a national priority. This system must be uniform and easily accessible for everyone. National (e.g. Medicare, Medicaid) and international (e.g. Britain's National Health Service) government programs in combination with the commercial sector of health service leaders are appropriate models. Using the systems and components that are successful in these entities will be the foundation.
The system will be managed through the government and insurance companies. The government seems most experienced and prepared for the task as an infrastructure already exists through the Social Security Administration and other government agencies. In addition, the information technology infrastructure is already in place. This provides the most extensive database of the nation's health care recipients that would be accessible to physicians and hospitals. This should ensure that all have access to the best comprehensive quality health care.
In order to attain the above, the employer-based model would be phased out. Purchasing health insurance from the government will subsequently be available to everyone. Each person will pay directly for services at prices comparable to Medicare and Medicaid fees. Through the Public Health Service all preventive screening will be done without charge. This will lead to a healthier people and a health system that takes care of everyone.
Great health is true wealth!
The system will be managed through the government and insurance companies. The government seems most experienced and prepared for the task as an infrastructure already exists through the Social Security Administration and other government agencies. In addition, the information technology infrastructure is already in place. This provides the most extensive database of the nation's health care recipients that would be accessible to physicians and hospitals. This should ensure that all have access to the best comprehensive quality health care.
In order to attain the above, the employer-based model would be phased out. Purchasing health insurance from the government will subsequently be available to everyone. Each person will pay directly for services at prices comparable to Medicare and Medicaid fees. Through the Public Health Service all preventive screening will be done without charge. This will lead to a healthier people and a health system that takes care of everyone.
Great health is true wealth!
miércoles, 16 de mayo de 2007
DOCTOR SEARCH ON INTERNET
Have you looked your doctors up on the Internet? When you do, you may find incomplete inconsistencies. Many web sites had no listing for several doctors I was looking up. So I looked at some others.
I went to the state medical board pages. I found that some doctors listed on the other web pages were not listed on the state board pages. Another doctor is listed with an active and an inactive license (several are listed like this). This doctor’s medical education and training have been done overseas. Some doctors have no residency training listed. This doctor has been in practice for 45 years, and is licensed in two countries and two other states. The doctor’s address is listed as a PO Box.
The type of information listed was different amongst the states. For instance, one state listed one line of information – license number, status of license, present location, disciplinary action (yes or no, not what), date of issue and expiration. Another state gives this plus the doctor’s education and training information, details of disciplinary legal action, other states/ countries where licensed, and board certification status. There were inactive licenses that were listed as active in another state’s information.
These incomplete inconsistencies are rather consistent. Do you know about your doctor’s background? Is your doctor properly trained and licensed? Which information is correct?
The American Medical Association (AMA) has a page with links to the state boards for licensing. Check your doctor at www.ama-assn.org/ama/pub/category/2645.html. Compare it to the information at “doctor finder” sites. Incomplete inconsistency.
I went to the state medical board pages. I found that some doctors listed on the other web pages were not listed on the state board pages. Another doctor is listed with an active and an inactive license (several are listed like this). This doctor’s medical education and training have been done overseas. Some doctors have no residency training listed. This doctor has been in practice for 45 years, and is licensed in two countries and two other states. The doctor’s address is listed as a PO Box.
The type of information listed was different amongst the states. For instance, one state listed one line of information – license number, status of license, present location, disciplinary action (yes or no, not what), date of issue and expiration. Another state gives this plus the doctor’s education and training information, details of disciplinary legal action, other states/ countries where licensed, and board certification status. There were inactive licenses that were listed as active in another state’s information.
These incomplete inconsistencies are rather consistent. Do you know about your doctor’s background? Is your doctor properly trained and licensed? Which information is correct?
The American Medical Association (AMA) has a page with links to the state boards for licensing. Check your doctor at www.ama-assn.org/ama/pub/category/2645.html. Compare it to the information at “doctor finder” sites. Incomplete inconsistency.
martes, 15 de mayo de 2007
WOMEN'S HEALTH WEEK
Ladies, it's time to schedule your screening and appointments to include:
- mammogram/ MRI for breast cancer
- PAP smear for cervical cancer
- stool check for blood (fecal occult blood test, FOBT) for colorectal cancer
- cardiology doctor for cardiovascular prevention
(get EKG, ECHO, and thallium stress test if indicated)
- bone density scan to check for osteoporsis
- counseling for smoking cessation, alcohol/drug dependence, and domestic violence
- evaluation for depression and other mental disorders if necessary.
This is in additon to a complete physical exam, and routine blood tests.
Get in 5 to 10 minutes of exercise a day at least and eat healthy! Laugh a lot and love a lot!
- mammogram/ MRI for breast cancer
- PAP smear for cervical cancer
- stool check for blood (fecal occult blood test, FOBT) for colorectal cancer
- cardiology doctor for cardiovascular prevention
(get EKG, ECHO, and thallium stress test if indicated)
- bone density scan to check for osteoporsis
- counseling for smoking cessation, alcohol/drug dependence, and domestic violence
- evaluation for depression and other mental disorders if necessary.
This is in additon to a complete physical exam, and routine blood tests.
Get in 5 to 10 minutes of exercise a day at least and eat healthy! Laugh a lot and love a lot!
lunes, 14 de mayo de 2007
TEST YOURSELF?
Many doctors are concerned that some tests like the body scan will lead to unnecessary procedures that could harm patients. Often these tests may show abnormal things that are “normal” meaning that the abnormal finding is something that is just there. It is benign, and not life threatening.
What does the doctor do when a patient comes in with a test that they have done on their own? The patient has decided that I may need this test because heart disease, and /or cancer runs in my family, plus heart disease is the number one killer. Should I have a heart scan, body scan or a virtual colonoscopy? My doctor has told me that tests like these may find things that are benign, but something serious may show up. It could be something that would turn up in a few years and possibly be life threatening, but if I check now maybe I can do something about it.
What does the doctor do when a patient comes in with abnormal test results from a test they orders and paid for themselves?
1. Repeat the test
2. Refer the patient to a specialist
3. Do more tests to check it out
4. Scold the patient and say “It’s okay. There’s nothing to worry about.”
What does the patient do?
What does the doctor do when a patient comes in with a test that they have done on their own? The patient has decided that I may need this test because heart disease, and /or cancer runs in my family, plus heart disease is the number one killer. Should I have a heart scan, body scan or a virtual colonoscopy? My doctor has told me that tests like these may find things that are benign, but something serious may show up. It could be something that would turn up in a few years and possibly be life threatening, but if I check now maybe I can do something about it.
What does the doctor do when a patient comes in with abnormal test results from a test they orders and paid for themselves?
1. Repeat the test
2. Refer the patient to a specialist
3. Do more tests to check it out
4. Scold the patient and say “It’s okay. There’s nothing to worry about.”
What does the patient do?
MISSED DIAGNOSIS
I read an article today about doctors missing diagnoses especially with cancer - OVER 50%!!
Are you getting the right treatment? A recent study* of 307 closed malpractice claims revealed that many missed or delayed diagnoses in outpatients lead to serious harm, some fatal. In this study, 30% resulted in death! Adverse outcomes occurred in 59%.
The most missed diagnoses were cancer (breast and colorectal primarily), infections, fracture, and heart attacks. Fifty-nine percent of errors were associated with cancer diagnosis - or should I say misdiagnosis? Most of these malpractice claims (59% again) showed that diagnostic errors were significant.
The most common reason for failure to diagnose was failure to order the right test (55%). The other reasons were:
-failure to follow up (45%)
-failure to obtain a complete thorough medical history and physical
exam (42%)
-wrong interpretation of medical tests (37%)
Some cases were cited where the doctor failed to check the test results, or to tell the patient the results.
This data is truly mind blowing! Though a small study, it carries a lot of weight. The percentages are phenomenally high! How can this be happening in the most medically advanced country in the world? The fact is, it's happening. It is more common than we think - hidden, not talked about. What can you do to keep it from happening to you?
Has your doctor discussed preventive tests for cancer detection? Of course, you should have a routine complete medical history and physical exam first. Using this information your doctor will know what tests you may need. If cancer runs in your family, you really want to consider preventive cancer screening.
The medical history and physical exam give your medical facts. Findings on physical exam may suggest cancer for which testing is needed. Some tests considered for routine cancer screening are:
-mammogram, MRI - breast cancer
-PSA (prostate specific antigen) - prostate
cancer
-colonoscopy - colon cancer
-stool blood check - colon cancer
-PAP smear - cervical cancer
-complete blood count - blood cancer
-CT or MRI scan - lung cancer, brain cancer
-pelvic sonogram - ovarian cancer
-body scan (neck to buttocks and in between) - body (this scan shows other things ,
too).
Screening tests save lives. Talk to your doctor. Be sure your doctor goes over the test results with you and explains EVERYTHING! Leave with your questions answered! Be sure to follow up with your doctor, too, to prevent any delays.
Get a copy of your test results. That way you will know if you were told everything and that the information is accurate. Research your results and diagnosis. Things you don't understand, ask again. Getting a second (and sometimes tiebreaker third because you were told different things by each doctor!)opinion is a reasonable research tool, also.
Patients must be their own advocate and take charge of their health. Health maintenance and prevention are so important to one's quality of life. Make it an important part of yours!
Remember to do your own monthly breast exams for both sexes, and monthly scrotal check for the males.
Great health is true wealth!
(*from AHRQ, Agency for Healthcare Research and Quality, publication "Research Activities" February 2007 from study in Annals of Internal Medicine, 10/3/06)
Are you getting the right treatment? A recent study* of 307 closed malpractice claims revealed that many missed or delayed diagnoses in outpatients lead to serious harm, some fatal. In this study, 30% resulted in death! Adverse outcomes occurred in 59%.
The most missed diagnoses were cancer (breast and colorectal primarily), infections, fracture, and heart attacks. Fifty-nine percent of errors were associated with cancer diagnosis - or should I say misdiagnosis? Most of these malpractice claims (59% again) showed that diagnostic errors were significant.
The most common reason for failure to diagnose was failure to order the right test (55%). The other reasons were:
-failure to follow up (45%)
-failure to obtain a complete thorough medical history and physical
exam (42%)
-wrong interpretation of medical tests (37%)
Some cases were cited where the doctor failed to check the test results, or to tell the patient the results.
This data is truly mind blowing! Though a small study, it carries a lot of weight. The percentages are phenomenally high! How can this be happening in the most medically advanced country in the world? The fact is, it's happening. It is more common than we think - hidden, not talked about. What can you do to keep it from happening to you?
Has your doctor discussed preventive tests for cancer detection? Of course, you should have a routine complete medical history and physical exam first. Using this information your doctor will know what tests you may need. If cancer runs in your family, you really want to consider preventive cancer screening.
The medical history and physical exam give your medical facts. Findings on physical exam may suggest cancer for which testing is needed. Some tests considered for routine cancer screening are:
-mammogram, MRI - breast cancer
-PSA (prostate specific antigen) - prostate
cancer
-colonoscopy - colon cancer
-stool blood check - colon cancer
-PAP smear - cervical cancer
-complete blood count - blood cancer
-CT or MRI scan - lung cancer, brain cancer
-pelvic sonogram - ovarian cancer
-body scan (neck to buttocks and in between) - body (this scan shows other things ,
too).
Screening tests save lives. Talk to your doctor. Be sure your doctor goes over the test results with you and explains EVERYTHING! Leave with your questions answered! Be sure to follow up with your doctor, too, to prevent any delays.
Get a copy of your test results. That way you will know if you were told everything and that the information is accurate. Research your results and diagnosis. Things you don't understand, ask again. Getting a second (and sometimes tiebreaker third because you were told different things by each doctor!)opinion is a reasonable research tool, also.
Patients must be their own advocate and take charge of their health. Health maintenance and prevention are so important to one's quality of life. Make it an important part of yours!
Remember to do your own monthly breast exams for both sexes, and monthly scrotal check for the males.
Great health is true wealth!
(*from AHRQ, Agency for Healthcare Research and Quality, publication "Research Activities" February 2007 from study in Annals of Internal Medicine, 10/3/06)
sábado, 12 de mayo de 2007
VACCINE VALIDITY
In this week’s New England Journal of Medicine the results of a trial for a quadrivalent (covers 4 strains of the virus) vaccine for HPV (human papilloma virus) were released. HPV has been shown to cause cancer of the cervix. About 70% of the cases are caused by strains HPV-16 and HPV-18. The vaccine works on four strains – HPV-6/11/16/18. “Conclusion: In young women who had not been previously infected with HPV-16 or HPV-18 those in the vaccine group had significantly lower occurrence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 than the placebo group.”
Does this mean that the vaccine should be mandatory law for eligible young females? What about the young males that may harbor this cancer causing virus? The article states in the second sentence that Pap smear tests have “led to a significant decline in mortality from cervical cancer in developed countries, such programs are costly and have not been effectively implemented in most developing countries”. It is hard to believe this new vaccine by Merck will cost less than a Pap smear, or that it will be covered by insurances like the Pap smear. Furthermore it only covers 4 strains of HPV. What about the other strains? Is it still possible to get the cancer if the vaccine is taken? Makes you go hmmmm. The article states that “the quadrivalent vaccine is prophylactic, not therapeutic.”
Though the vaccine was found to reduce cancer of the cervix, it still occurred in some who had gotten the vaccine. It occurred more in those who did not receive it. One case was found to be from another strain, HPV-52. At the beginning of the study about 11% in the placebo group (did not receive vaccine), and about 11% in the vaccinated group had abnormal Pap smears. It is unclear if these were the same ones that developed cancer. Since the vaccine does not cover all strains, but reduces the overall number of cancer cases, should it be mandatory for young teens? Has there really been enough research to warrant this?
Side effects? The primary side effect reported was due to pain at the injection site. There were other side effects reported. This is mentioned in the article, but there is a separate supplement that documents these. In the supplementary appendix the most common were “gastrointestinal disorders”, “infections and infestations” and “general disorders and administration site conditions”. Others included “injury, poisoning and procedural complications”, “musculoskeletal and connective tissue disorders”, “immune system disorders”, and more. “Nervous system disorders” were the leading system side effect. The specific details of these conditions were omitted. The article itself mentioned neck pain and seasonal allergies. It seems the information from the supplement should have been front and center. Hmmm.
The clincher is that some women became pregnant during the study. They had already received the vaccine. Pregnancy complications and congenital defects in the babies were reported in the supplementary appendix.
Ironically, the last page of this supplement to the article was a chart for Pap smear management. The chart showed what to do for abnormal Pap smears, a “mandatory regimen for triage of abnormal Papaniclaou (long word for Pap) tests to colposcopic exam.” Colposcopic exam, colposcopy, is a test to check for cancer. It seems that Pap tests are still reliable, safer, and more cost effective.
This article, the supplement, and tables were hard to decipher. This is how I interpreted the results after reading it several times. It would be interesting to know how many doctors will pass all this information along to their patients of whom this will be required. After full disclosure, it should be up to the patient (and her parents) – Pap smear to check for early cancer or HPV vaccine to possibly prevent cancer. Hmmm.
Vaccine validity or more drug deception?
Does this mean that the vaccine should be mandatory law for eligible young females? What about the young males that may harbor this cancer causing virus? The article states in the second sentence that Pap smear tests have “led to a significant decline in mortality from cervical cancer in developed countries, such programs are costly and have not been effectively implemented in most developing countries”. It is hard to believe this new vaccine by Merck will cost less than a Pap smear, or that it will be covered by insurances like the Pap smear. Furthermore it only covers 4 strains of HPV. What about the other strains? Is it still possible to get the cancer if the vaccine is taken? Makes you go hmmmm. The article states that “the quadrivalent vaccine is prophylactic, not therapeutic.”
Though the vaccine was found to reduce cancer of the cervix, it still occurred in some who had gotten the vaccine. It occurred more in those who did not receive it. One case was found to be from another strain, HPV-52. At the beginning of the study about 11% in the placebo group (did not receive vaccine), and about 11% in the vaccinated group had abnormal Pap smears. It is unclear if these were the same ones that developed cancer. Since the vaccine does not cover all strains, but reduces the overall number of cancer cases, should it be mandatory for young teens? Has there really been enough research to warrant this?
Side effects? The primary side effect reported was due to pain at the injection site. There were other side effects reported. This is mentioned in the article, but there is a separate supplement that documents these. In the supplementary appendix the most common were “gastrointestinal disorders”, “infections and infestations” and “general disorders and administration site conditions”. Others included “injury, poisoning and procedural complications”, “musculoskeletal and connective tissue disorders”, “immune system disorders”, and more. “Nervous system disorders” were the leading system side effect. The specific details of these conditions were omitted. The article itself mentioned neck pain and seasonal allergies. It seems the information from the supplement should have been front and center. Hmmm.
The clincher is that some women became pregnant during the study. They had already received the vaccine. Pregnancy complications and congenital defects in the babies were reported in the supplementary appendix.
Ironically, the last page of this supplement to the article was a chart for Pap smear management. The chart showed what to do for abnormal Pap smears, a “mandatory regimen for triage of abnormal Papaniclaou (long word for Pap) tests to colposcopic exam.” Colposcopic exam, colposcopy, is a test to check for cancer. It seems that Pap tests are still reliable, safer, and more cost effective.
This article, the supplement, and tables were hard to decipher. This is how I interpreted the results after reading it several times. It would be interesting to know how many doctors will pass all this information along to their patients of whom this will be required. After full disclosure, it should be up to the patient (and her parents) – Pap smear to check for early cancer or HPV vaccine to possibly prevent cancer. Hmmm.
Vaccine validity or more drug deception?
jueves, 10 de mayo de 2007
DRUG DECEPTION
“BREAKING NEWS. Oxycontin executive admits to misleading public…” and doctors. The newscaster comments, “Does this mean they lied?” Yes, it does. Same story, different day. What else is there to say…
martes, 8 de mayo de 2007
Health Channel
Medical information on TV is limited and stagnating. Sixty seconds on the news. Two minutes on the talk show after commercials on prescription medication. Outdated show on this channel, and outdated repeat on that channel in between the new show. Watch some on this channel then click and click to different channels to connect your medical news for today.
Remember the crawler at the bottom of the screen. Oh, you missed that there was a bird flu outbreak in Pakistan today, and that HPV vaccines will be required for teen women (what about the men?). These are the ways we learn about some of the most important news we should know. It concerns our health and public safety.
If only we had a dedicated medical TV CNN (instead of just Dr. Sanjay Gupta’s excellent show on early weekend mornings, or his occasional special). You know, like the sports channels by sport, the cartoon channels by age (and now one for the boomers!), the movie channels, government channels, and on and on. Where is the “MTV” of medical channels? Discovery Health has been carrying the TV health media for years. There should just be more!
The TV box is probably the most used medium by which folks get their news and information. It is certainly a way to get information to people. The most used information source is one of the least used by the cutting edge medical field. This was noted in my research paper, “Building an American Health System”, in 2002. This is 2007, and it’s pretty much the same, maybe even less.
A medical TV channel (actually several would be optimal) would be great! A daily health news show would be a great start towards 24-7 medical TV. Envision yourself clicking to the heart channel, or to programs with content about specific diseases. You could learn more about that high blood pressure you are trying to control, and how you can monitor it at home. Topics on maintaining good health, and prevention of disease would be a click away. And if you missed a show, it would be shown again and again.
Health and medical coverage on TV is surely lacking in this consumer driven health conscious society. We can watch as much sports, cartoons, movies, news as we want, but we still have to piece together our medical news and supplement it with the written word, or health care providers’ spoken word. And radio.
Great health is true wealth. Medical TV would make us even richer.
Remember the crawler at the bottom of the screen. Oh, you missed that there was a bird flu outbreak in Pakistan today, and that HPV vaccines will be required for teen women (what about the men?). These are the ways we learn about some of the most important news we should know. It concerns our health and public safety.
If only we had a dedicated medical TV CNN (instead of just Dr. Sanjay Gupta’s excellent show on early weekend mornings, or his occasional special). You know, like the sports channels by sport, the cartoon channels by age (and now one for the boomers!), the movie channels, government channels, and on and on. Where is the “MTV” of medical channels? Discovery Health has been carrying the TV health media for years. There should just be more!
The TV box is probably the most used medium by which folks get their news and information. It is certainly a way to get information to people. The most used information source is one of the least used by the cutting edge medical field. This was noted in my research paper, “Building an American Health System”, in 2002. This is 2007, and it’s pretty much the same, maybe even less.
A medical TV channel (actually several would be optimal) would be great! A daily health news show would be a great start towards 24-7 medical TV. Envision yourself clicking to the heart channel, or to programs with content about specific diseases. You could learn more about that high blood pressure you are trying to control, and how you can monitor it at home. Topics on maintaining good health, and prevention of disease would be a click away. And if you missed a show, it would be shown again and again.
Health and medical coverage on TV is surely lacking in this consumer driven health conscious society. We can watch as much sports, cartoons, movies, news as we want, but we still have to piece together our medical news and supplement it with the written word, or health care providers’ spoken word. And radio.
Great health is true wealth. Medical TV would make us even richer.
Patient Advocate
The “Vital Signs” of patient advocacy:
TRUST
CARING
COMMUNICATION
COMPASSION
EDUCATION
INFORMATION
KNOWLEDGE
A patient advocate is someone who cares for and helps monitor patient's medical care. You should be your own patient advocate as well as an advocate for loved ones, friends. Doctors should act as their patients’ advocates. This seals the patient-doctor bond and assures them that they will get everything they need in a timely manner.
TRUST
CARING
COMMUNICATION
COMPASSION
EDUCATION
INFORMATION
KNOWLEDGE
A patient advocate is someone who cares for and helps monitor patient's medical care. You should be your own patient advocate as well as an advocate for loved ones, friends. Doctors should act as their patients’ advocates. This seals the patient-doctor bond and assures them that they will get everything they need in a timely manner.
martes, 17 de abril de 2007
Time for Yearly Check-up
It is time for me to schedule my yearly physical. Last year this time I was getting my annual physical in preparation for surgery. That went very well after much preparation and many doctor visits over 2 years. Finding the right doctor is so important especially when you are dealing with medical conditons that are "unknown" so to speak. By this I am referring to conditons we don't know a lot about; therefore, treatment is usually not definitive if there is treatment that works.
That's why it is so important to know what you have and do research on it. The yearly physical is a way to keep up with your health before little things become big things.
As I look over my "grocery list" of things to discuss with the doctor, I am amazed to see how many are unresolved, and fortunately not life-threatening. It was a task to try to get them all taken care of before my surgery last year. I kept track of them, so I will include them in my visit for my checkup. I have noticed that if you have more than three medical conditions and if they are not in the "top three" - hypertension, arthritis, diabetes - your other diagnoses tend to get less attention, if any. Furthermore if you smoke or have obesity issues, these are more likely to take up most of the doctor's time. Furthermore if you smoke or have obesity issues, these are more likely to take up most of the doctor's time. Doctors, like most people, are most comfortable with what they know.
So you have to stick to your "grocery list". After awhile I had to expand to writing/ typing everything down in my "medical diary" because too much stuff was getting left out. That way I was able to keep up with the unresolved as well as resolved issues. Trying to get my doctor up to speed was less successful. This created a lot of anxiety so much so that I developed "white coat" hypertension! This is high bllod pressure associated with going to the doctor. Sure enough, my blood pressure checks at home were okay.
As I prepare for this yearly ritual, I try to ease my anxiety and keep my blood pressure down. After all it makes no sense to get so worked up over something good for your health. With all the life-saving medical technology we have today, the basic yearly physical checkup is still one of the best health tools ever.
That's why it is so important to know what you have and do research on it. The yearly physical is a way to keep up with your health before little things become big things.
As I look over my "grocery list" of things to discuss with the doctor, I am amazed to see how many are unresolved, and fortunately not life-threatening. It was a task to try to get them all taken care of before my surgery last year. I kept track of them, so I will include them in my visit for my checkup. I have noticed that if you have more than three medical conditions and if they are not in the "top three" - hypertension, arthritis, diabetes - your other diagnoses tend to get less attention, if any. Furthermore if you smoke or have obesity issues, these are more likely to take up most of the doctor's time. Furthermore if you smoke or have obesity issues, these are more likely to take up most of the doctor's time. Doctors, like most people, are most comfortable with what they know.
So you have to stick to your "grocery list". After awhile I had to expand to writing/ typing everything down in my "medical diary" because too much stuff was getting left out. That way I was able to keep up with the unresolved as well as resolved issues. Trying to get my doctor up to speed was less successful. This created a lot of anxiety so much so that I developed "white coat" hypertension! This is high bllod pressure associated with going to the doctor. Sure enough, my blood pressure checks at home were okay.
As I prepare for this yearly ritual, I try to ease my anxiety and keep my blood pressure down. After all it makes no sense to get so worked up over something good for your health. With all the life-saving medical technology we have today, the basic yearly physical checkup is still one of the best health tools ever.
domingo, 1 de abril de 2007
TOC FOR PATIENT HANDBBOOK TO MEDICAL CARE
"Patient Handbook to Medical Care: Your Personal Health Guide" is a source for helping patients. The book's introduction states that "The goal of this book is to inform and educate patients about medical care...It is very important for patients to learn as much as possible about wellness, disease prevention, and disease management for themselves."
TABLE OF CONTENTS
Chapter 1
Medical Records and Diary
Chapter2
The Doctor Visit
Chapter 3
Preventive Checkups and Health Maintenance
Chapter 4
Medical Tests
Chapter 5
Doctors and Specialists
Chapter 6
Health Insurance and Quality
My Health Notes (last pages)- blank pages to start medical diary
TABLE OF CONTENTS
Chapter 1
Medical Records and Diary
Chapter2
The Doctor Visit
Chapter 3
Preventive Checkups and Health Maintenance
Chapter 4
Medical Tests
Chapter 5
Doctors and Specialists
Chapter 6
Health Insurance and Quality
My Health Notes (last pages)- blank pages to start medical diary
sábado, 31 de marzo de 2007
DOCTOR VISIT TIPS
Going to the doctor can be quite a challenge. "Patient Handbook to Medical Care: Your Personal Health Guide" is the perfect tool for patients to make their visits worthwhile.
One of the first things you want to do is make a written or typed medical history to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago.
Start keeping a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.
Request copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to legibility. It is surprising to see how many doctors are often unable to read their own handwriting.
Stay on top of your health care with these tips. After all, great health is true wealth!
Stay well,
doctorj
P.S. What tips do you have for doctor visits? Share your experiences.
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