Friday, August 24, 2012

Know Your Family (medical) Tree!

It is so important to not only know your own personal medical history but also the medical history of immediate family members. I cannot stress how important this is! One of the most frustrating things a doctor has to "deal with" is a patient having absolutely no idea of what their medical problems are, or what medications they take. I'm not asking you all to try and memorize everything if its extensive (like waiters try and do, and then mess your order up)...write them down and put it in your wallet!

There are a number of reasons why this is so important. One, if, heaven forbid, you or a family member has to go to the hospital and are unable to communicate, a piece of paper with medications and medical history is invaluable to the physician treating you. Also, and I have mentioned this before, YOUR screenings for different diseases/cancers may change depending on your families history. For instance, if you are so lucky that no one in your family has had any medical may not matter. BUT, if your mom had breast cancer at 45, then guess what? Now, your first mammogram needs to be at 35, not 40. Same holds true for colon cancer. Some medical conditions have a very strong genetic component (especially some heart problems) and it is very very important to know this. If your brother passed away suddenly at 22 years old from a heart condition...that is important info!

Interestingly enough, the ACC (American College of Cardiology) recently sent out a newsletter/study showing that having a close relative dying of heart disease doubles a persons chances of developing heart disease themselves by age 50. Scary stuff, huh? The study went on to show that  "losing two of more close relatives to cardiovascular disease by age 60 more than tripled the odds that someone would develop it before age 50", while "having a less-immediate family member, such as a grandparent, die young of cardiovascular disease also modestly increased a person's risk by 19 percent". homework for this weekend and upcoming week is to write down your medical problems and medications and any immediate family members medical problems...put it in your wallet/purse..and do not remove! Believe it or not, this little thing could be a life saver!

Thursday, August 16, 2012

Obamacare...Nuttiness in a Nutshell!

Ahh...both my favorite and least favorite topic to talk reform. I feel that, being a physician practicing in a community hospital it is time to give my rant about this media-driven topic. There is way too much information that is left out (probably on purpose) about this bill that my readers...male and female..need to understand. It's time to get dirty let's do it.

Although this "bill" has many many thoughts...the main point of the bill that most are focusing on is the increasing insurance coverage to Americans. Let me fill everyone in on this. The government is proposing that increasing medicaid will solve the problem. Newsflash...this will not even begin to help. Let me explain...medicaid is a government-funded insurance which is provided to low-income patients/ families. Sure, in theory this sounds great, but ask most people with this insurance how easy it is to find a doctor. Unfortunately, not at all easy. Why? Because the government's reimbursement (or payment) to physicians for services rendered is deplorable. It is basically the equivalent of paying your plumber $5 to fix every pipe in your house. So, what happens is that the majority of physicians do not accept medicaid patients because frankly, they just do not get paid enough. You may see that a physician is a medicaid "provider" but this does not mean that he/she is actively accepting patients.

I urge everyone not to get upset reading this. It is just the simple truth. Most physicians have thousands (if not hundreds of thousands) of dollars in student you can imagine why a doc would not want to accept such an insurance who basically, does not pay them. I would bet that most docs would rather see an uninsured patient and have them pay a nominal fee cash, then deal with medicaid. So from this, you can see that increasing medicaid will NOT solve the "insurance" problem. All this will do is have more patients with an insurance that less physicians accept. Oh, and finding a primary care doc who takes medicaid is hard enough...good luck finding a specialist...few and far between!

The reform also implies that giving people access to insurance will reduce costs in terms of unnecessary ER visits. No way. Having insurance will not all of the sudden make people less scared. Patients will still continue to go to the ER at 2am with a cold or STD. Having insurance will not change that. There are "community health centers" in almost every town across America, which are completely underutilized because frankly, people would just rather go to the ER.

One of my biggest problems with the reform is the increase in tax on drug companies and medical device makers. Okay..let me fill you all in on some behind-the-scene stories. I can tell you all that not ONE day goes by where an insurance company (especially medicaid) denies a medication because it is too expensive. Although numerous studies show that the more expensive drug is WAY better then the cheaper one, they just don't want to pay for it. So, what happens? The wonderful drug company typically offers the medication to those people who cannot afford it at a very discounted price or even FREE! Now, what do you think will happen when these companies begin to get taxed more? Goodbye free medication...and your doctor's hands will be tied..This is the worst part of my job. Knowing that a patient could be getting a better medication or treatment, but their insurance company just will  not pay for it.

Currently in this country, you are not denied medical care. If you walk into any ER needing an emergent surgery, having a heart attack, or any other real medical problem, you will get care, insurance or no insurance. No waiting, no payment upfront. So saying that "everyone deserves healthcare" is correct...and it is happening right now.

Sure, there are some good an insurance carrier not being able to deny coverage based upon a pre-existing condition..thats great! However, overall, this bill is just a total mess...and until physicians who actually practice out in the real world everyday become a part of making this plan and reform better, we will not get anywhere.

There you have it...Obamacare's Nuttiness in a Nutshell. I have another ten paragraphs I could write on this, and some solutions I have...but maybe they are better served in a different post..I know all of your eyes are getting awfully heavy!

Please read here on my CNN iReport more about this heated topic...herehere.

Also, another doctor friend of mine had a lot to say about this topic..if you are still not convinced..:) You can check Dr. Manuel Diaz's


Wednesday, August 8, 2012

A Side Effect for You...and a Side Effect for Me!

First, I would like to apologize for taking so long to write another post. Apparently doctors get sick too..who would've thought?! Anyway, I am feeling well enough to get back to here we go!

One of my biggest pet peeves as a doc is patients and their obsessions with medication side effects. Don't get me wrong, side effects happen..for sure...HOWEVER...most people blame their medication for side effects that, not from the medication. What people fail to realize is that just stopping their medications without first talking to their doctor may be just as dangerous.

First, lets talk about side effects that are actually listed, like on the package insert on your medication. The side effects listed are ANY and ALL complaints that the patients in the trial listed that they had while taking the medication. If ONE person had a cough in the whole group, it had to be listed. Doesn't it make sense now that basically every medication on earth has "nausea, vomiting, body aches, headache and cough" listed? Of course! Because with or without the medication, most people will experience those symptoms in a period of 6 months.

Lipitor, a very popular "statin"
A very simple analogy is that of "statins", a very popular class of cholesterol medications. These medications are "known" to cause muscle damage and liver damage. The fact of the matter is, these medications are extremely useful and important in those patients who have high cholesterol. I always have patients who hear of this side effect and that side effect so they refuse to take a medication that could potentially save their life. In this particular example, muscle damage only occurs in about 0.1-0.5% % of cases, and the FDA has recently revised it's labeling information in regards to liver damage and liver function testing with these medications, because it happens so infrequently.

Also, remember that everyone's body is different. Just because your great aunt twice removed has a bad side effect does NOT mean that you will too! With that being said, it is very important to speak with your doctor regarding any major or the most common side effects of any newly prescribed medication. Your physician will be able to tell you what is dangerous and what is not, as well as the most common complaint from patients. A lot of the time, side effects are transient and go away with continued use of the drug. My favorite was the patient who had an obvious cold..sniffling, sneezing...and had a dry cough. Which started at the same time as the cold...and what did she do? Blamed the medication for the cough. No, she had a cold..that's why she was coughing. But, I have realized that patients will blame their medication for everything!

Most importantly, call your doc immediately if you believe that you are having a serious side effect of a medication. This is for two, so you can receive proper care for the problem, and two, to see if it is actually safe for you to discontinue the medication abruptly. There are some medications that need to be tapered, and cannot be stopped all at once.

With that, I did find some pretty funny side effects of some medications that are quite...interesting...and bring a little humor to the world of medicine...

1. Alli- weight loss drug. Side effects listed: gas with oily spotting and loose stools which may be hard to control
2. Requip- for restless leg syndrome. Side effects listed: an unusual urge to gamble

That's all for now, folks!