Doctor Shortage Delays Medical Care

Physician demand in all specialties is greater than the supply.  As the population grows the number of doctors is decreasing.  The 2036 projected shortage in the United States is 86,000 according to the 2023 study by AAMC (Association of American Medical Colleges).

The Covid pandemic worsened the crisis as more doctors left physician life primarily due to money.  During this time Medicare continued to decrease doctors' reimbursement for medical services rendered to elderly and disabled patients.  Basic costs like office rental or purchase, malpractice insurance, employee salaries were the main sources of money outflow.  All of these were increasing as were costs for an aging population most of whom had at least five chronic medical conditions.

As a potential physician shortage may be approaching, it has become more difficult to get timely appointments.  If you have insurance, they must be in network to avoid extra cost beyond your insurance coverage.  This usually means longer wait time primarily due to smaller listing of doctors.  Many physicians also have limited visiting hours unlike days of old when they made themselves more available to patients than two days a week.

In addition, doctors are more specialized and selective in their choices.  One choice is cash only payment instead of insurance, Medicare, or Medicaid.  Another choice is the specialty or subspecialty chosen.  The more specialized are usually more expensive and highest paid. Some have gender and age preferences. Burnout due to overworking has led to limits in the number of new patients for some doctors, or just quitting.

Patients should try to find doctors they feel are best for them and their family.  Even if it means consulting several in the same specialty until you get the right one.  Doctor shopping is becoming more popular as the healthcare landscape keeps rapidly changing.  The Internet makes it easier to do, but the telephone makes it more personable.  Talking to someone can give you more informatiom and add to your research.  Word of mouth is still a good way to find doctors.  Seek out the best doctors and you will find trustworthy personalized precision health care for you.  Best health!

Fever and Malaise: Flu or New Disease

Fever. Chills.  Malaise. Myalgia. Loss of appetite.  Cough.  These symptoms are consistent with the flu syndromes such as influenza.  They may also be signs of new inflammatory disease like infection in the body. Cancer and rheumatological disorders that include connective tissue diseases and arthritis may also present in similar fashion. Flu symptoms usually resovle in about ten days to two weeks.  Complications from the flu like pneumonia are likely to cause worsening of symptoms accompanied by new symptoms.

Flu precautions include:

• frequent hand washing especially after contact with others
• avoid those who have flu-like symptoms
• cover your mouth when you cough
• eat nutritious foods especially those that are specific for immunity and healing
• stay well hydrated
• get flu shot before flu season starts
  

These preventive measures are important for staying well and healing.  If your symptoms persist or worsen in any way follow-up with your healthcare provider that initially diagnosed you. Telemedicine health visits help contact avoidance while getting appropriate medical care for you.  Healthy self care, prevention, and avoidance are primary. Best health!

Home Health Care Heals Healthier

Did you know most Medicare expenses are utilized in the last year of life?  This fact has become more recognized as patients find themselves financially unable to afford proper services to maintain an independent quality of life.  In addition, many over 60 years of age have multiple chronic conditions.  Aging plus chronic conditions that may have become disabling can make health diagnosis and treatment less effective yet more challenging to all healthcare providers.  This also includes family and non-family caregivers who must give up their time, job, etc. to help with care that is unaffordable on a fixed income.


Home based health care is on the rise as the population ages.  More patients than ever before are transitioning to healthcare in their homes including primary care provider visits, tests, and treatment. Studies have found that home health care keeps people healthier and out of the hospital.  It is only natural that the best place to heal and recover is home.


Hospital discharge planning has prepared you for your return home. Most of your care and treatment can be at your home. The old-fashioned housecall remains an important part of medical care.  Most of all it provides continuous continuity at a time when you are unable to physically go to your healthcare providers office.  This is further enhanced with modern technology such as telemedicine.  The convenience and quality time spent with patients in home care lets the doctor, nurse practitioner, physician assistant, nurse, and other ancillary providers see you in your natural environment of everyday living.


Home health care includes personal care, too.  Often this service is necessary for help with bathing, dressing and activities of daily living.  Cooking and light housekeeping are just a few of the other services that may be offered.  Patients are able to recover comfortably and quicker when this type of home assistance is included.  Though rarely covered by regular insurance, it is an important part of any home care plan.  Saving money over the years for home personal care should be included in your financial plan especially long term.


Many primary care providers do well care in the home, too.  Minor medical maladies and routine medical care are easily rendered during a house   call. Timely appointments can be made to fit your schedule. As this method of direct primary continues patients are seeing better health outcomes especially after hospitalization.  Readmissions within thirty days are less likely.  Best of all the patient feels better and recovers more quickly.  Home based health care provides greater continuity of care and active, current communication for the patient and all those involved. Get better, stay better at your house.  Best health!

Part 1: Basic Diagnostic Health Tests

These basic health tests can help your doctor with your diagnosis and treatment. Know what they are so you know that you are getting it when it is needed. These can be baseline, and routine screening tests as well. 
The EKG, also known as an electrocardiogram, gives information about your heart. It is usually done by the primary care doctor as part of a routine physical, especially if heart disease runs in your family. Typically, this test is done on anyone complaining of chest pain or discomfort. Small patches with adhesive on the back are placed on the chest, arms, and legs while the patient lies on her or his back. The electrode patches are attached to the wire cables running from the EKG machine. The heart’s electrical activity is recorded on paper. By looking at this “heart tracing” graph, the doctor can tell if there are any abnormalities like irregular heartbeats (called arrhythmias), damage to heart muscle from a heart attack, poor blood flow to the heart that causes chest pain (called angina), and heart enlargement. The doctor has been trained to know what changes or abnormalities need further testing, treatment, or hospitalization.
The X-ray test uses small amounts of radiation through an X-ray machine to make pictures. It can be done on almost any part of the body to check out a patient’s symptom, and/or the doctor’s findings during the physical exam. Many primary care doctors have X-ray equipment in the office. If not, the patient may be referred to a special office (diagnostic center) that performs X-rays or to a local hospital radiology department.

X-rays are most commonly done on the chest, abdomen, back, joints, and extremities (arms and legs) and are done either with the patient lying down or standing up, depending on the part of the body being checked. After you have been positioned, the X-ray film cassette is placed in the machine next to the body part being X-rayed. The radiation from the machine will pass through the body part being X-rayed onto the film. The radiology technician (the person who operates the X-ray machine) will then move to a closed space in the same room and press the buttons to take the X-ray.

During this test it is important that a protective lead shield apron be placed over the reproductive parts of the body.  Usually the technician will need to take more than one view, and so you will be asked to move a certain body part or turn a certain way. Different X-ray views give the radiologist (the doctor who reviews and interprets X-rays) a more complete view of the body part. Using the information from this test and the information from your history and physical, your doctor will be able to determine the proper diagnosis (what the problem is), treatment, and/or more tests, if needed.

There is some concern that the radiation from X-rays may be harmful. Studies have shown that small amounts of radiation are not linked with an increased risk of health problems. Over the years the amount of radiation used for X-rays has been decreased.



If you are uninsured, these tests are still available at affordable rates.  Check and compare prices by phone or Internet to find lowest prices.  Your healthcare provider may also be able to direct you to a clinic, hospital or testing center that fits your budget.  Some providers also have payment plans that allow payment over time.  Make your own healthcare plan affordable rather than go without.  Best health!

Mobile Healthcare:Telemedicine Telehealth

If you could visit your doctor 24/7 how much money and time could you save?  Telemedicine healthcare makes this possible.  Telemedicine makes virtual reality a reality as real as visiting your doctor in the office.  Through your smart phone, tablet or computer you can make a doctor visit.  No travel time. No wait time. Just quality doctor time.

Telemedicine is a billion dollar business that is becoming a trend in our connected world of convenience and crucial time management.  It entails the use of electronic communications to monitor and improve a patient’s health status.  In addition to saving money for patients and all providers (including insurance companies, hospitals, clinics), there is better access for everyone. Studies have shown that overall quality of care improves as patients are given more of the attention they deserve to make their healthcare experience more beneficial. .  It is helpful for patients in remote areas with limited or no transportation and those with chronic conditions that limit their ability to make an in person office visit.   

As telehealth develops, doctors and patients will find even greater access with connectivity via personal electronic health devices and applications (apps, for short).  Telemonitoring allows patient and doctor to check and follow together such parameters as blood pressure, blood sugar, and much more in real time together.  If that noon time blood sugar is too high, your doctor can be aware and advise accordingly at the time of occurrence instead of on the next appointment in 2 weeks.  This alone saves the patient’s health as well as travel time, office visit wait time, and the money to do all of this.  It potentially avoids an emergency room visit and hospital admission. 

In addition to patient care, doctors are able to communicate in a more timely, efficient manner with other doctors and health facilities.  The CT scan you had this morning is can be viewed by your doctor within minutes after completion instead of days after. Mobile collaboration allows your doctor to discuss your health case with other healthcare professionals like specialists (in the same or different locations) to determine the plan for your care.  This can actually happen the same day a test is done!  This eliminates delays in care that could be life threatening to a patient. 

As costs for telemedicine access decrease and more insurance companies/plans reimburse, it will become the portal of choice for many patients, doctors, and other healthcare providers.  Your doctor visit time can be more about you at your convenience in your home.  Best health!

Personalized Precision Medicine

As we look forward to medical breakthroughs of the future, precision medicine becomes more of a reality in your medical care. Precision medicine uses treatment and intervention based on a person’s genetic and non-genetic (e.g. lifestyle, environment).  Unlike the present but ever changing protocols for wellness and disease management that are used on everyone, precision medicine is individualized just for you.  It will be your own prescription for staying well and treating your ailments. 

The basis of precision medicine is genomics.  Sequencing of your genome is done.  This molecular process identifies normal and abnormal genes.  Genomic mutations are studied and tested for different characteristics.  The results of this testing allows for prevention, diagnosis, and treatment based on your molecule makeup within your genes that have been influenced by family history, lifestyle, and environment.  DNA analysis of your genes in addition to a thorough history and physical will help your doctor determine what you have and what health risks may be present.  This information will then be used for further diagnosis and treatment.  Prevention of conditions that you are prone to develop may be less likely to develop if at all.

Precision medicine has become prevalent in drug treatment as well as disease diagnosis.  Clinical pharmacogenetics makes use of patient’s genetic data as a guide for drug therapy.  This information can then help your doctor pick the right medication for you. Pharmacogenetic information for blood thinners like coumadin and clopidogrel can be helpful in choosing which will work best for you with least complications.  Neonatal (newborn) diabetes and mature onset diabetes of the young (MODY) are rare causes of diabetes.  The cause of these types of diabetes is from an inherited mutation of one gene (monogenic).  Genetic testing can make the correct diagnosis that would otherwise be missed or misdiagnosed.  Some cancers have specific gene mutations that can be detected and treated successfully based on this information.  Drugs are made to target these and eradicate the cancer.

Thousands of disease genes and genetic tests have been discovered since the Human Genome Project of 2003.  As costs go down and precision medicine improves, personalized medicine will get more precise.  Prevention instead of treatment will be more likely.  Genetic tests and treatments for the individual will be precisely what the doctor orders for you.  Best health!

Keep a Happy Heart, Be Heart Smart

A healthy heart is a cheerful heart.  Keep your heart smart and happy with this quick, easy to understand information.

Check your heart list:
___Heart and vascular exam by health care provider
___Blood pressure, pulse, weight, height
___EKG

For further evaluation, especially if symptoms are present, and/ or if there is a strong family history of heart and vascular disease see a cardiologist.

Tests may include:
___Doppler echocardiogram (checks heart valves, size, etc.)
___Stress test - nuclear, doppler or exercise (heart function)
___Heart MRI scan (artery disease)
___Interventional studies like cardiac catherization, angiogram (checks artery blockage, valve function)

Heart health habits:

1. Maintain a healthy weight.
2. Eat healthy small portions.
3. Exercise regularly - every little bit counts! Just do it regularly.
4. Keep blood pressure under control.
5. Keep stress level low.
6. Get adequate sleep.
7. Take an aspirin a day if in a high risk group. Check with your health care provider.
8. Love, laugh, and let go!

Have a happy, healthy heart! Best health and love!

J.L. Richardson, MD, family medicine, is the author of the award winning Patient Handbook to Medical Care: Your Personal Health Guide.

Internet Information and Your Health

Health information once obtained from bought or borrowed hard copy books, magazines, and papers is now available on your computer in seconds. Many studies have shown that the Internet is rapidly becoming the main source of health information for patients and health care providers around the world.  This has made it a tool of preventive medicine individually and globally.  Many are able to "pre-diagnose" themselves and maintain wellness by the time they seek medical care.  This makes for a shorter differential diagnosis dilemma for your doctor; thereby, shortening the time for correct diagnosis and treatment.

Health literacy on line also includes abundant applications for your smart phone and computer, interactive social media, and websites from health providers and institutions.  One of the most interactive and informative is Twitter.  Lists such as these for doctors,  http://bit.ly/2XWKw29 and medical/health http://bit.ly/2GWkbvH  contain lots of information that links directly to sources. Most of these include websites as well as individual snippets of information called "tweets".  Searches for specific health information can also be done using the internal search box.

While the Internet may help diagnose, it far from replaces your doctor's advice. Use it as a health literacy tool to educate yourself.   Check out "What the Internet Does for You and Your Health" http://bit.ly/a3RAjw for more health literacy lessons. Best health!

What Your Blood Tests Really Mean

When the doctor orders blood tests (also called lab tests, blood profile/ panel), she or he is checking for certain things. The most common tests are CBC (complete blood count), basic complete blood panel, and UA (urinalysis). The CBC checks the body’s WBCs (white blood cells) and RBCs (red blood cells). In the lab the cells are examined for size, shape, and number. The WBCs may tell if you may have some type of infection or leukemia(cancer of the white cells). The RBCs carry oxygen to the rest of the body. This is done by hemoglobin, which is carried inside the RBCs.  Some inherited diseases, such as sickle cell
anemia and thallassemia, can be identified by abnormal RBC shape and size. Also included in the CBC is a platelet count. Platelets are cells that help your blood to clot, for instance to stop the bleeding after a flesh wound.

The basic complete blood panel measures many different things. Included in these tests are:

• Na = sodium

• Cl = chloride

• K = potassium

• Mg = magnesium

• Glc = glucose (sugar)

• Ca = calcium (bone mineral)

• PO4 = phosphate (bone mineral)

• BUN = blood urea nitrogen (kidney)

• Cr = creatinine (kidney)

• SGOT = serum glutamic oxaloacetic transaminase (liver)

• SGPT = serum glutamic pyruvic transaminase (liver)

• GGT = gamma glutamyl transferase (liver)

• Alk phos = alkaline phosphatase (liver, bone primarily—also gallbadder)

• Fe = iron

• TIBC = total iron binding capacity

• transferrin = iron

• uric acid = checks gout

• chol = cholesterol (fat)

• LDL = low density lipoprotein (“bad” cholesterol)

• HDL = high density lipoprotein (“good” cholesterol)

• TG = triglycerides (fat)

Blood panels may differ from lab to lab. The above tests make up the basic chemistry panel. This should be part of a routine checkup. Some panels may include more tests than those listed above. The urinalysis (UA) may or may not be included, but it is important. Urine tests are able to check for infection, sugar, blood, protein, and many other things. Additional tests that may be ordered by the doctor for preventive screening will depend on your symptoms, diagnosis, family history, and age. Some of these tests are:

• PSA = prostate specific antigen (prostate cancer test)

• TSH = thyroid stimulating hormone (thyroid function)

• T4 = thyroid hormone (thyroid hormone level)

• B12 = vitamin B12

• folate = B vitamin

The Pap smear test and stool for occult blood (blood in stool that cannot be seen with the

naked eye) should also be performed. The Pap smear is a test for females that checks for cancer of the cervix. The stool test, also called Hemoccult test, checks for blood in the stool, which may indicate bleeding from the bowels secondary to cancer, ulcers, or other serious conditions.


Other tests than those listed may be checked depending on your history and physical exam. Be sure you are scheduled for a return visit to follow up on all tests. Some doctors’ offices will also let you know by phone or mail, especially if there is an abnormal test that must be checked before your next appointment.

Your symptoms, the doctor’s physical findings, and blood test results are what the doctor looks at when deciding the next tests that need to be done. This and any additional tests may be used for screening, diagnosis of conditions, and for ongoing management of disease once it is present.

Making the Most of Your Doctor Visit

When you go to your doctor or health care provider, you should be prepared.  This is one way you can be sure that your doctor visit focuses on your most important health issues. The following suggestions will help you get the most out of your doctor vist.

• Be on time.
• Make 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.
• 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.
• Get 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.
• Take advantage of the time your doctor takes looking through your medical chart during your visit by taking your own notes especially questions. As much as 1/3 of your visit time can be consumed by this alone.
• Allow each other to talk without interruption. 
• Bring a trustwothy companion.

Click on "Comments" below to add your tips or ask questions.


*medical history form http://www.mypatienthandbook.com/

Ovarian Cancer: Early Detection

September is teal time for Ovarian Cancer Awareness Month.  Ovarian cancer kills many women quickly and silently.  It is one of the cancers that is hard to detect.  The treatment is pure hell and the vague symptoms become unbearably painful.  Ladies, there is something we can do! The pelvic and transvaginal sonogram (also called ultrasound) is a simple test that every woman should have just because you are a woman. Like the mammogram, this medical test is inexpensive and non-invasive (unless vaginal insertion is considered so) as far as no IVs or contrast dye.  Consuming mass amounts of water until you have to urinate (but must hold) is the least discomfort you should experience.

Talk to your doctor about pelvic sonogram screening.  Most gynecologists have them in their office which is excellent standard of care and convenient for the patient.  It can be done and read the same day by your gynecologist, possibly by the time you sit down to talk after the exam.  The pelvic and/or transvaginal sonogram becomes part of your medical record for easy reference as needed thus providing consistency and, if necessary, for future comparison.  These tests are also becoming more readily available for direct consumer purchase without prescription at diagnostic centers and through health fairs.

The CA-125 blood test may be useful; however, it is nonspecific and may be seen with other conditions like endometriosis, pregnancy, fibroid tumors, diverticulitis, and liver cirrhosis.  It has been proven to be a reliable tumor marker once ovarian cancer is diagnosed. CA-125 tests, like the pelvic songram , is not recommended for women at average risk of ovarian cancer.  High risk patients like those with a family history of the disease, mutations in BRCA1 or BRCA2 genes, or suggestive symptoms are encouraged to get tested.

Early detection of ovarian cancer saves lives as well as fertility especially for women of childbearing age.  For these reasons alone sonograms should become part of every woman's prevention schedule on a routine basis like the mammogram.  The patient's quality of life can be saved in a cost effective manner.  The nonspecific symptoms of pelvic pain, low back pain, abdominal pain (bloating, fullness, distension), changes in bowel or bladder habits are surely worth looking into, but can lead your doctor into a quandry with many other diagnostic tests before ovarian cancer is suspected. The time this takes can definitely delay diagnosis. 

Speak up before the silence of ovarian cancer quiets your life.  Though unpreventable there are things you can do to lower your risk.  This includes oral contraceptives, genetic counseling, and removal of ovaries (oophorectomy).  Seek care and advice from experts in these areas via your gynecologist. The National Ovarian Cancer Helpline is very good for locating local resources. http://www.ovarian.org/local_chapters.php

Without a bonafide early detection test for ovarian cancer, we still must do all we can to detect early and prevent the rampage of this deadly disease.  The pelvic and transvaginal ultrasound along with a thorough pelvic exam can reduce the sounds of suffering that ovarian cancer shouts out in silence.

Colonscopy for Colon Cancer Screening

Have you had your colonoscopy?

• baseline if 50 years of age
• history of colon cancer in family
• personal history of colon polyps, cancer
• rectal bleeding
• have a disease that is a risk like Crohn's disease
• chronic abdominal pain
• rapid unexplained weight loss

Check with your primary care physician. You will then be directed to your gastroenterologist (GI doctor, for short) for a complete evaluation. Ask your PCP for occult blood stool cards to take home to check for blood in the stools.

The Hemoccult test checks for blood that is not detected by the human eye. After you complete your stool sample cards, return to your PCP by mail or in person. They will be checked by your doctor. Any GI exam without this test and/or a rectal is incomplete.

Best health!

J.L. Richardson, MD is a family medicine doctor, patient advocate, author and publisher of Patient Handbook to Medical Care: Your Personal Health Guide.