What if you’re afraid of needles?

First, please don’t worry!  Most people find acupuncture to be quite painless.  I’m extremely sensitive myself, and I’m used to working with patients who are sensitive or nervous.

If you still decide that you’d rather not have needles at all, again, don’t worry.  We can treat you by doing contact needling, touching a blunt silver needle (kind of like a small knitting needle) to the surface of your skin.  Or I can treat points by touching with my finger, or by taping on small metal pellets.  Magnets are another possibility.

We can also treat you with energy work in a more general way, without using the system of points, but acupuncture points are so helpful that I think you will prefer to have them involved.  I usually teach patients points they can press to treat themselves at home, too.

There are lots of possible ways to reach your goal of feeling good and having a body that works the way you want it to.  Let’s find out what will work best for you.

*

Love, Fear, and Viruses: Some Ways We Make Ourselves Ill or Well, Part I

Elene Explores

“The wound is the place where the Light enters you.” ― Rumi

I am so grateful to be past the series of respiratory infections that first hit me way back on January 28. Lots of people in Albuquerque have gone through something similar, but it seems like I set a record for duration of cough. Not only was it obnoxious in itself, it made work and anything I did in public difficult. It was also bad for my reputation as a healer! My newest patients, who had never seen me healthy, were becoming convinced that something was terribly wrong with me, and my established patients were making noises about my not taking proper care of myself (whereas I was doing everything I could think of to get better). I wasn’t looking like a good example for them, that’s for sure.

I don’t like blaming patients for getting sick, but I…

View original post 1,580 more words

“Dry Needling” vs. Acupuncture

KH Warren DN infographic

Image

A Patient’s Experience, Expressed in Poetry

Posted with the kind permission of the author.

Poem for Elene

“That’s a nice image,” you said
As I lay on your table
Tiny needles emerging
From points
you carefully chose.
“Bumblebees aren’t supposed
To be able to fly
According to the science
Of aerodynamics,
But they don’t know that:
So, they keep flying anyway.”
In my mind
I see
A fat black bumblebee
Stumble his way
Into a pale, veined, delicate
Flower
Disappearing into its folds.
The flower bends
With the bumblebee’s weight
Until the bee emerges
Seconds later, looking for another bloom.
You are busy near my feet.
“How’s the headache?” you ask
As you put your hands on my temples.
You move to the other end
Of my body
Where I feel you
Pulling energy [worry, stress, fatigue]
Out of my toes. Then
You gently work on my neck.
You pull on my neck— ah, heaven.
I relax,
Wanting to sleep for a long time
Right there on your table.
I leave……..I go home
Feeling peaceful………..
As peaceful
As I felt last summer
As I watched
The
Unhurried,
Purposeful,
Impossible
Flight of the bumblebee.

— Diane Plummer
5/21/06

Bonding with Complex Creatures

Posted at “Elene Explores” on 5/18/15  http://elenedom.wordpress.com

Colorful_Parrots_Couple

Macaw photo credit: Riza Nugraha on Flickr

Our local PBS channel reran a 2013 Nature program, “Parrot Confidential.” http://www.pbs.org/wnet/nature/parrot-confidential-parrot-confidential/8496/ It’s about the fascinating complexity of parrot brains and behavior, and makes the point that birds in the parrot family are wild animals that in many ways are unsuitable as pets. They have been extremely popular, though, and huge numbers of them are homeless refugees in the US, because people buy them and then find themselves unwilling or unable to keep them. A great many have been poached from the wild, and in an attempt to prevent that from happening, bird lovers have bred them domestically. Eventually this turned out to be compounding the problem, so breeders shut down their operations, and now everyone who wants a parrot is strongly encouraged to adopt one from a shelter. Habitat loss as well as poaching has threatened parrots in the wild, with the ironic result that their numbers in their native countries are decreasing even as shelters here are bursting at the seams.

But pet parrot overpopulation, while I want to spread the word about it, is not my main subject for today. I guess my subject is “bonding with complex creatures.” It seemed to me, when I watched the program, that the parrot experiences could teach us a great deal of what we humans need to understand about relationships.

One of the difficulties, and at the same time one of the joys, of living with a parrot is its deep attachment to its human companion. [Disclaimer: I do not live with a parrot and never have— I only know about this from observation.] The program explained why this is so. Parrots spend virtually all their time with their mate, and the human becomes a mate substitute and is also expected to give 100% attention. This is likely not what the human expected.

Among the parrots featured by the Nature team was a yellow-naped Amazon named Basil. He had done well with his human family for his first four years, bonding especially strongly with the husband, until he hit puberty. Then suddenly it was no longer okay that the husband was away a lot on business. The wife and kids became Basil’s targets, with the wife getting the brunt of his wrath. He would actually fly at her and attack her, and had to be locked in his cage to protect her and the children.

Parrot-Confidential-Basil1At one point during this period, the family wanted to take a vacation. They had friends who also had a male yellow-naped Amazon, and they asked to leave Basil at their house. Neither bird had ever had the opportunity to interact with another of his kind, and as soon as they met, they were best friends.

Two weeks went by, and Basil’s family returned. They put him in his cage and started out the door, and as they were leaving, the other bird, Coco, began to scream, with total clarity, “NO! NO! NO! NO! NO!” (And some people say that birds can’t use human language appropriately.) Well, no one could hear that heartrending sound and not be moved. They immediately brought Basil back, and it was decided that he would stay and be adopted by Coco’s family.

I was much moved by Coco’s pleas myself, and it seemed to me that what he was saying was something fundamental to all of us. More and more I think that relationships boil down to something very simple. Most creatures with some degree of awareness want to bond with others of their kind, or failing that, others of some kind.

If you put someone in a cage, they will not be at their best. One of the experts said that sometimes he is asked what the right size of cage for a macaw is, and he replies that it’s 35 square miles, their range in the wild. There is no right-sized cage, he said. For anyone, probably.

If you expect someone to act in a way that is contrary to their nature, your expectations will not be met. We were told that people ask for a bird that sings, that is quiet, and that doesn’t bite, and that there is no such species.

The main character in this presentation was Lou, a cockatoo who had been left alone to starve in his cage when his family’s house was foreclosed upon. The humans had just up and left him in the empty house. Fortunately, the neighbors noticed that something was amiss, and they had animal control come and look into the situation. The very traumatized and timid Lou was taken to a shelter filled with dozens of other cockatoos. He had to be quarantined for a month, and then he was placed into the aviary, still in his cage in order to protect him from possible aggression. When the staff finally decided it was safe to open his cage, he climbed to its roof, and a beautiful scene ensued. One of the females, Princess, sidled over to Lou in the most non-threatening and gentle way, with her back to him, as if to say, “Don’t mind me, not trying to bother you, just cleaning my wings over here.” Lou seemed to light up, and a moment later the two were preening each other’s neck feathers and clicking beaks as if they’d been together forever.

Humans make everything about relationships incredibly more complicated, with all sorts of arbitrary rules. I wonder if we could try just settling down with each other sometimes and sharing a nice piece of fruit or something.

 

We think of the natural world as a place of ruthless competition, but as Lynne McTaggart made clear in her book The Bond, cooperation is more prevalent and more beneficial. It can be shown rigorously, through game theory, that cooperation generally leads to the best outcomes for all. Many times, though, altruism seems to gain an animal nothing in particular except perhaps a pleasant feeling. McTaggart began the book* with an example of not a dog-eat-dog but a dog-help-dog story. It seems that her own dog was crazy about the dog next door, and although there was no advantage to be had for mating (both dogs being fixed), or anything at all other than friendship, he shared food and toys with her whenever he got the chance.

I know not every kind of animal enjoys company like this, but through the magical power of Facebook videos, I’ve marveled at the variety of animals who do. Even creatures as “unintelligent” as tortoises interact with other animals in fascinating and complex ways. Every species from bats to wombats seems to appreciate care and snuggling under the right circumstances. Humans are no different.

*http://thebond.net/ I went to find a link to the book for you, and found that there are other related materials available. Haven’t checked these out as yet.

______________________________________________________

After working on this post during the afternoon, I attended a web meeting of a new organization that’s trying to form, based on Alex Loyd’s book Beyond Willpower. The central idea of the book is extremely simple: You can have love, or you can have fear. If you act out of love, things will generally go well, and if you act out of fear, they will tend to go badly. At the time that the book was published, earlier this year, I was encountering this idea over and over in various places. I don’t think there is a more important concept anywhere. It transforms everything. The group intends to help spread the transformation.

Aggression and other negative behaviors have fear at their core. There is fear of abandonment, for example, at the bottom of the violence Basil the parrot visited on his family when his preferred human was not at home. Humans have the choice to think more clearly about the reasons for their behavior and to change it for the better.

http://beyondwillpowertogether.com/

How to Treat Plantar Fasciitis at Home

I often see patients complaining of heel and sole of foot pain. They may identify it as plantar fasciitis, or they may simply point to the spot that hurts. Most of them have shown the classic pattern, in which they have the most pain on first stepping out of bed in the morning, then feel better for a while, then have more pain again after being on their feet for a long time through the day. So many people have this pain going on that I want to get the word out more generally about how to relieve it, instead of just telling my own patients one at a time.

This common condition usually responds well to self-care, which is crucial whether one is working with a health-care professional or not. Let’s look at what’s going on in the leg and foot and what you can do about it.

The term plantar fasciitis refers to inflammation of the fascia, the connective tissue, in the sole of the foot. (Plantar means anything having to do with the sole of the foot, as in plantar warts, often mismentioned as “planter’s warts.”) Very often, the pain is felt mainly or entirely in the center of the heel. There is a simple reason for this. The Achilles tendon connects with the foot right there, and when the tendon is tight, it pulls on its attachment to the bone, which hurts, sometimes quite a lot. This can affect one or both feet.

Generally speaking, although the pain can feel like you’ve got a rock in your shoe or like there’s a sharp object inside your heel itself, this is not necessarily being caused by a heel spur, which is a growth of extra bone on the calcaneus (heel bone). Heel spurs often cause no symptoms at all, and may or may not exist at the same time as plantar fasciitis. If you do have a heel spur, don’t panic. The usual treatment is the same as what I am describing here, and it is very unlikely that you will need surgery or any kind of drastic intervention.

Why is the pain worse first thing in the morning? During the night, your ankle extends, since you are not putting weight on your foot, and the back of your calf is allowed to shorten (as is the sole of your foot). As soon as you do put weight on the foot, your ankle must flex so that your foot is flat on the floor, which pulls on the back of your calf. The tight muscles and tendon suddenly yank on that attachment at the heel and on the sole of your foot in general. After you walk around a bit and get things loosened up, the discomfort eases. Then, after some hours of weight bearing, your inflamed, upset fascia starts to get more irritated and lets you know. Sitting for long periods may cause a similar effect to lying down overnight.

You can see that a big part of the solution is to open up the tight tissue so that it’s not pulling this way and can let the plantar fascia calm down and heal. If you have this problem, you will probably find distinctly tight, tender knots in your calf muscles and/or above your heel. Podiatrists typically prescribe stretching of the calf, which is good and necessary, but the trouble is that if you stretch aggressively without doing anything to loosen those tight knots first, you will probably just irritate and aggravate the situation more.

So here’s what you need to do: Feel around throughout your calves and ankles for tight areas, which may be exquisitely sore to the touch. When you find them, gently press and massage them. Experiment with the amount of pressure; you need to be firm enough to make a positive change, but you don’t need to torture yourself. Keep at it until the knots release and the spots aren’t so tender. I recommend doing this before you go to sleep and before you get out of bed in the morning, but anytime is OK. For some reason, massage of the calf is virtually never mentioned by podiatrists or in articles on plantar fasciitis, but I find it to be the most important aspect of treatment. You should start feeling improvement pretty quickly, maybe even immediately. You can also massage the soles of your feet themselves.

Heat may be helpful to help the muscles relax. Ice or cold packs may feel good on your feet to reduce inflammation. You may need to rest from your usual activities, especially if sports or excessive standing or walking are causing pain— but you don’t want to be so immobile that you end up with more stiffness and tension. Whatever makes you feel better is fine with me. I treat patients with acupuncture for the knotted muscles and inflammation, and I use microcurrent stimulation on the feet, since needling directly into the sole can be unpleasant. Professional massage, osteopathic manipulation or other manual therapy, or chiropractic could also be useful. Whatever you choose, self-treatment is going to be extremely important.

What caused the calf muscles and Achilles tendon to get so tight to begin with? There could be a number of factors, such as lack of exercise, too much muscle-building exercise without enough attention to flexibility, a previous injury that has led to muscle imbalances, or wearing inappropriate shoes.

Often adding arch support will go a long way toward solving the problem— although an overly intense or rigid arch support, or one that doesn’t fit well, can contribute to causing it, as once happened to me. Try different shoes and different arch supports to see what seems to work best for you. You don’t have to spend a fortune on orthotics to start with; begin with inexpensive store-bought types and see how you do. It’s possible that you will in fact need custom orthotics in the long run, but you don’t need to start there, and if someone tries to sell you on very pricey ones, I suggest that you put them off for now. Also, some people are comfortable with very firm arch support, while others need as much softness as possible to comfort their sensitive soles.

I have seen a couple of cases that didn’t respond to these basic strategies, but they are rare. It may take a number of weeks or even months for the pain to resolve completely, but you should be seeing definite improvement soon. If that doesn’t happen, something else is going on and you will want to look further.

DOMs Are THE Qualified Acupuncturists

Physical therapists and others have been doing “dry needling,” which is a form of acupuncture for trigger points.  They have simply not had the training we’ve had, and are doing a far more limited form of treatment.  This summary will make the situation and your choice clear:

“Know Your Acupuncturist”

CCAOM_KnowYourAcu

Health Care Access, and Why PCPs?

Grant's rainbow 2.2.14A friend posted this picture of a rainbow that appeared two days ago in our area, a most welcome sight since we had had no moisture at all for over 40 days.  The rainbow showed up just after her neighbor died after a long illness, giving its benediction to the family.  Last night we had a fair amount of rain and snow, and it feels like we will not dry up and blow away just yet.

I am trying to keep up some hope for our health care system as the conflicts over so-called “Obamacare” continue and costs keep spiraling upward.  There does seem to be some lucid thinking going on in at least scattered spots among those in the medical field and those making policy, and I want to encourage that.  There’s also a lot of the same old thinking that got us where we are today.  Here is my current take on some aspects of the situation, which I sent to the Albuquerque Journal today:

The Journal has published some useful articles lately on problems with access to health care, and I’d like to add my perspective as a provider out in the field.  There are three main issues with access to care for New Mexicans: distance, cost, and scarcity of providers.

I don’t have to tell you that for many of our residents, most everything is far away.  Even in our smaller cities, there are not a lot of services.  In Grants, where I see patients once a week, medical specialists come in from Albuquerque or elsewhere, as I do.  People who need VA services must go to Albuquerque, no matter how elderly or disabled they are.  It’s bad enough in a small city like Grants, but people who live in more rural areas, as some of my patients do, may be completely out of luck if they lack transportation.

Getting more New Mexicans insured is necessary and commendable.  However, this does not remotely solve all the problems with the direct cost of medical care to consumers.  As those who are shopping on the state exchange have no doubt noticed, many plans have deductibles in the thousands of dollars.  Also, with some plans patients pay as much as 90% of the cost of the service themselves, even after their deductible is met, because their copays are so high; they are paying for coverage that they don’t get. The ACA was intended to bring deductibles and copays into the realm of reason, if I understand correctly, but as it is, cost limits access even for those who are insured.

For those on Medicaid, at least, copays are low or nonexistent.  However, very basic and critically necessary care may not be covered.  For example, one of my elderly patients needs drops for an unusual and painful eye condition caused by her recent case of shingles.  The cost is low compared to most of her care, but Medicaid is not covering this medication, and on her extremely limited Social Security income, this lady can’t afford enough of it to last through the month.  For all the millions we spend as a state, we still can’t get people simple things that they need badly.  And while the myriad costs add up to so many millions, Medicaid and Medicare payments to providers are so unsustainably low as to keep providers out of the programs, exacerbating the access problems all the more.

Our state’s lack of health care providers has multiple causes, but it also has the potential for multiple solutions.  Making better use of mid-level practitioners, as many have suggested, is certainly necessary, and any efforts which will attract more health care workers are worth trying.  However, there are other available health care forces which are only partly being tapped.  One of your editorials did refer to “traditional community health workers,” by which I assume you mean people like curanderas/os and Native healers.  Encouraging greater use of their abilities would be a definite help– but how is that going to be funded?  For the most part our insurance system has ignored the existence of these valuable resources, as it has ignored herbalists, homeopaths, and those who do energy healing such as Reiki.  Most federal dollars will also bypass all those practitioners and the people who rely on them.

New Mexico has a formidable and growing health workforce in the members of my profession, Doctors of Oriental Medicine.  We too are being used far less efficiently than we could be, even though most commercial insurance in the state does cover our services.  Decision makers don’t seem to realize how much primary care we do– and we have not yet managed to get the word out to them sufficiently.  We are lumped in with “rehabilitative medicine” by insurers, but that is only one aspect of our medicine.  Patients walk in to acupuncturists’ offices with everything from flu to IBS to sciatica, and we treat them effectively.  We are well placed to help take the strain off of primary care MDs, and we are ready and willing to serve.  However, provider groups organizing “patient-centered medical homes” have generally not included us in their planning.

Medicare does not cover acupuncture, and under most circumstances Medicaid also does not, largely because the federal dollars are not available to make that happen.  Attempts to fix this in the state and federal legislatures have failed thus far.  So immediately a huge proportion of our population is left out of a major form of effective and cost-effective medicine.  And while our NM-based insurers do offer coverage, as I mentioned before, in many cases reimbursement is slim and patients are left to pay as much as 90% of the charges, so that this “coverage” is not very meaningful.  (Fortunately, there are also many plans with much better coverage, I must add.)  Yet, many patients do use us as their front-line care providers, and that could be expanded.

There are still other possible providers as well.  In some situations a chiropractor may be the best choice to see first, and access can be a bit easier than that for DOMs, with so many chiropractors available and a good number of them accepting Medicare.  For at least some conditions these practitioners could also help to ease the burden on primary care MDs.  Physical therapy is usually given limited coverage, and patients tend to be referred to PT only after they have failed to get better for a long period of time.  That is inefficient and leads to unnecessary suffering.  We could use PTs more as the first choice, go-to practitioners for injuries, back pain, and the like.

There is one access problem that would be very easy to solve, IF those who are in charge were willing.  That is the system of HMO and PPO networks.  It was unconscionable when Lovelace ended its relationship with ABQ Health Partners and tore hundreds of thousands of New Mexicans (including my family) away from the doctors they knew and trusted.  Now Presbyterian has stopped coverage to the UNM providers, again leaving patients in the lurch.  We could stop this kind of abuse, I expect, legislatively or perhaps through actions of the state insurance department.  I am not holding my breath, but as the provider crunch gets more and more serious, I hope access will be broadened across insurance networks.  There is no good reason for things to be this way; we all pay and we all deserve to have the best providers for our needs.  HMOs were supposed to reduce costs and improve health outcomes.  Neither has happened.  Time for a different approach.

And we do have a different approach waiting in the wings: the home-grown, NM-specific Health Security Act is still here and has been gathering more and more support over the years, though so far it hasn’t made it past all the Powers That Be.  In the next few years we will have the opportunity to improve upon the current health insurance exchange and enact this more efficient plan.  We can choose to do it– it’s just a matter of willingness.

OK, that’s what I sent off to the newspaper a moment ago.  Continuing:

Let’s say that a patient has jumped through all the hoops of distance and cost and gotten the coveted access to care, and is now sitting in the doctor’s office.  Now the main barrier is time.  The patient may have waited months for this appointment, but she is going to be very lucky to get more than 10 minutes of the doctor’s time.  And maybe even that pittance may soon be a luxury.  An editorial written by two local executives with Presbyterian Health care and published a few days ago stated that because of the pressures on PCPs, we have to find some alternative to the standard 15-minute appointment with the physician, such as group appointments for people with common conditions like diabetes.  Wait just a MRSA-contaminated minute here!  We pay more and more and more for our supposed health care every year, we are totally breaking the bank, we are stressing the whole country out trying to fix all this, and we can’t even get a measly 15 minutes with the Minor Deity?  Seriously?  (Meanwhile, the Deity is struggling to stay afloat in a world of shrinking reimbursements and greater pressures on his or her business.)

I must say that on the fairly rare occasions when I’ve gone to an MD, as for my yearly OB-GYN checkup, I’ve had more like a 25-minute appointment.  I hear that this is not usual, but it has been the norm for me thus far, perhaps precisely because I’m not there all the time– I’m having more than just brief followup appointments.  So I have a little bit of hope, but again, as the provider crunch gets worse, that hope is likely to evaporate.

(Appointments with me as the doctor, in contrast, are still normally scheduled for an hour or more.  My patients who have gone to community acupuncture or to other colleagues who see multiple patients in an hour tell me that they appreciate the difference.  I find trying to treat more than one person at a time very stressful, in addition to feeling that I can’t be as effective, and I have no intention of doing that on a regular basis, but the squeeze on insurance reimbursement may force me to change my ways eventually.  I hope not.)

Now let’s think about what actually happens during that 10, 15, or possibly 25 minutes.  What are primary care physicians for, and do they fulfill that purpose?  One of the main things they do is to prescribe and authorize refills of medications.  In the case of chronic illnesses, they should be able to help the patient maintain well and deal with any changes in their condition that come up.  Well, last week one of my patients, who has been taking Synthroid for decades since she had thyroid surgery, went to see her new PCP, who had been forced upon her by the issue I mentioned above, Presbyterian ending its relationship with the UNM system.  Her last PCP had reduced her dosage, and she had done extremely poorly until she figured out the problem– herself– and started taking the higher dose again.  She explained all this to the new guy, but he flat-out refused to consider prescribing the dose she needs.  Total failure both at paying attention to the patient and at delivering the treatment.  Especially at paying attention!  I wish I could say this was unusual, but it’s what I hear from patients over and over and over, and it seems most common with regard to thyroid issues.*  In this case, there was an out– I sent the patient to a colleague of mine who specializes in endocrinology and can prescribe natural thyroid extract.  Not everyone has such an alternative, and many patients go without effective treatment.

The other main thing a PCP is “for” is to be on the lookout for problems and do something about them before they get worse.  Often they really shine in that role.  A few weeks ago we got my mother’s PCP appointment moved up because she was getting markedly weaker and often short of breath.  The PCP (Ann Jones, MD, about whom I have few complaints) didn’t like the way my mom looked either, and sent her for extensive testing at the ER space across the parking lot.  They didn’t find much, but my mom came home– after an exhausting 9 hours– with a clear diagnosis and a prescription that has been noticeably helpful.  That’s more or less how things should work.**

On the other hand, a patient who has recently entered the Medicare age group went for her first ACA-mandated Medicare yearly wellness checkup around the same time.  This lady has had a chronic cough and severe fatigue for months, following a period of extreme stress, and although she’s improving, no clear cause has been found and the problem has been hard to treat.  The idea of these yearly exams for Medicare is supposed to be to give the patient a thorough going-over so that any problems will be found and dealt with appropriately, keeping them from getting worse and causing more cost and suffering.  My patient reported that the appointment lasted less than 10 minutes, she barely had the opportunity to ask any questions, her main complaint was not really addressed, and no treatment was suggested.  And this is a very assertive and articulate patient.  So it didn’t seem like the purpose of the exercise was fulfilled at all.

The PCP is often the most accessible and cost-effective person for performing minor, in-office surgeries.  And of course the PCP can order tests, which will either show that there’s no problem or perhaps guide the path to more specialized care.  When I had that health scare back in August, I ended up with Bob’s PCP, Oswaldo Pereira, MD, who had no more idea what was going on than I did, but could send me for further testing.  We ruled out a number of possibilities, and that was helpful and quite necessary; I needed to know that I didn’t have a cardiac issue, for example.  However, Dr. Pereira never came up with either a diagnosis or a treatment.  Since we couldn’t find anything dire, and since I was gradually getting better, we both dropped the matter.

I had the most significant improvement with a structural approach, under the care of my friend Christine Dombroski, PT.  Dr. Pereira, thoughtful and knowledgeable as he is, would never have thought to send me there, and didn’t really understand why this helped.  It’s just not part of the way MDs are usually trained.

I love the PCPs of the world and feel sympathetic toward them, but the more I consider all this, the more I think our typical use of them is a bit misguided.  I’d like to end with some fairly obvious statements about when to head for your PCP’s office, and how to use that system appropriately.  First, please do not see the PCP when you have a cold!  You will accomplish nothing except to waste time and money, tire yourself out when you need to rest, and spread viruses around the office.  Even a run-of-the mill case of flu is not a good reason to go to the PCP, unless you have an underlying condition that makes it more dangerous; all they can do is give you Tamiflu, which works poorly if at all, and tell you to rest and drink fluids, which you already know.  (Do feel free to see me or my colleagues, as we can actually treat you!)

Do head for urgent care or the ER if you have severe unexplained pain, trouble breathing, or other scary symptoms that are not resolving in a reasonable way at home.  And of course if you are having any signs of a possible heart attack or stroke (I should write another post on those), you should call 911 as soon as you can reach the phone.

*It doesn’t have to be that way.  Both my last PCP and my OB-GYN tend to dose thyroid replacement on the basis of symptoms rather than strictly by blood test results.  They are not unique, fortunately, just not the rule. 

**Update, later in the day:  This morning my mother saw Dr. Jones again, and she is leaving most medication issues up to the specialists.  So I ask again, what is the PCP for?  It’s not easy for 89-year-olds to get to appointment after appointment, nor for their families to get them there.

As I was writing this, I came across a great Medscape article by a doctor who has a vision of what a true health care system could be like.  You may have to sign up with Medscape to read it, but if you have any interest in medical matters, it’s well worth it.
http://www.medscape.com/viewarticle/819947?nlid=46863_1521&src=wnl_edit_medp_wir&uac=167278MR&spon=17

Here the author imagines an idealized school health teacher:
‘”She sat down with all of the physical-education, biology, and health-education teachers in her system, and together they outlined a plan to change the curriculum such that health education starts in kindergarten. In their system, by the time children reach the 12th grade, they know which side hurts when their appendix is about to rupture. They know the warning signs of a heart attack. They know when to start screening for colon cancer, and they know when it’s appropriate to access the doctor’s office, the urgent-care clinic, or the ER. They understand the basic dangers and positives of over-the-counter medications. In other words, by the time someone puts a high school diploma in their hands, they are as well equipped to take care of their bodies as they are to find their favorite iPhone app.

“They understand the difference between a carbohydrate and a fat and which foods fuel their systems to fight cancer, heart attack, and stroke. They are not going to be obese because they know to exercise at least 150 minutes per week. Mrs J’s students are going to cost us less and live longer. They will live better with more money in their pockets, because they won’t have to buy a laundry list of prescription medications every year until they die prematurely from a preventable illness.’

And here’s her imaginary doctor who figured out a fix for electronic health records:  ‘Then, there’s Dr P [for practical]. Although we acknowledge the necessity of electronic health records [EHR], our earliest efforts have failed the patient. A doctor’s daily work has ground down to a snail’s pace. Patients complain about the basic lack of eye contact during an office visit because the doctor is focused on a screen. Dr P revolted against that practice. He designed a system where there are shorter updates at each visit and there is a symptom-limited entry into each subsequent visit. You don’t have to go through 900 reviews of systems that have nothing to do with why this particular patient has come to see you. He does only a positive review of systems. He took the time away from his EHR and gave it back to his patients, and his patients are more satisfied and better taken care of because of it.’

All this could happen.  There’s no reason why it couldn’t.

Previous Older Entries