Thursday, September 29, 2011

"Test Me for Everything!"

There was an excellent article in the New York Times today entitled, "Why Doctors Order So Many Tests."  I encourage everyone to check it out, along with the comments.

Those of you that are my patients know that I try to take a pretty minimalist approach to testing and medications.  I encourage people to make lifestyle changes before taking medications, if appropriate.  I do not encourage so-called "screening" tests unless they are recommended by the USPTF.  For example, I've spent plenty of time trying to convince patients that they don't need a full body CT scan and that certain women don't need a Pap smear every year.  Some people take my advice, some don't.  And that's fine.  All I can do is make recommendations based on my expertise.  After that, it's up to the patient.  They are the steward of their own health, and I have no problem with that.

One of the toughest things I have to do is convince people that antibiotics are not needed for a self-limited infection.  This is one thing that I do not cave on- no one can force me to write a prescription that I don't feel is indicated.  However, I can't stop someone from heading over to the ER or urgent care center.  Nothing frustrates me like telling a patient that they don't need antibiotics for their bronchitis, and then having them go to the ER a day later and be given a Z-Pack.  This will typically be followed by a phone call from the patient saying, "You wouldn't give me an antibiotic and I had to go to the ER.  I took the Z-Pack and I was better in a week."  My response to this- you would have been better in a week anyway, with or without an antibiotic.

Please, I beg of everyone- try to think of antibiotics as a life-saving treatment that is reserved for a serious infection.  Our armamentarium is limited, and over-prescribing of antibiotics has the real potential to put us back in the pre-penicillin days.  That is a scary, scary thought.

Wednesday, September 28, 2011

Favorite Apps

I've already mentioned previously how in love I am with my iPhone.  I wanted to spotlight some of my favorite apps that people might find helpful.

This is my favorite running app- RunKeeper.  It has some great features.  First of all, it uses the GPS on your phone to track speed, distance, and pace.  With a flick of the screen, it will pull up Google Maps and trace your route.  It keeps a history of your runs, so your progress is tracked.  Turn on the "coaching" feature and the program will give voice prompts for what to do.  You can create your own workout, also.  Even better, you can program a playlist from your iPod so the workout is synced with music.  Once you're done, you can tweet about your workout or post your results to Facebook (not that I've ever done this, but it's easy to do).

Oh, by the way, if running's not your thing, you can set it for pretty much whatever activity you want- biking, hiking, skiing, snowboarding, even swimming.  Swimming???  How, exactly, does one swim with a smartphone?  At any rate, if you want to destroy your phone, apparently you can track your progress via GPS while doing it.

Stay tuned for more of my favorite apps!

Tuesday, September 27, 2011

Study of the Week!


Now, this is my kind of medical study!  These results were published in the Archives of Internal Medicine this week.  It looked at data from the Nurse's Health Study, an amazing study that has been going on since the mid '70 and has analyzed data from over 200,000 participants.

The most recent analysis looked at data from over 50,000 women.  It showed an association between higher intake of coffee and lower incidence of depression.  The more coffee, the lower the risk of depression.

So, what can we take from this study?  Mostly, that we need more studies.  While there is an association between the incidence of depression an caffeine consumption, we can't say yet that caffeine actually can prevent depression.

I will say this, though.  For most people, it's fine to have a cup or two a day of coffee.  Enjoy!

Sunday, September 25, 2011

Backyard Chickens

These are my chickens.  Well, some of them at any rate.  Right now I have 25.  Within the next few weeks I'll be down to about 14, as I will be sending most of the roosters to freezer camp.


Why do I have chickens?  Well, the eggs are incredible.  Really, if you've never tasted a farm-fresh egg, try to find some.  You'll never go back to supermarket eggs.  The chickens eat all sorts of yard pests, like grubs and ticks.  They are very low maintenance- we give them water and food once a day and clean out the coops every few weeks (takes under an hour). They also provide my kids with hours of amusement:


Alex hasn't caught a chicken yet, but that doesn't stop him from trying.  Not that he'd know what to do if he ever actually caught one...

Friday, September 23, 2011

Behind the scenes

This is my paperwork.  It takes up about 2 hours a day, every day.  This is in addition to the 8 hours I am seeing patients.  It consists of lab and x- ray results, prescription refills, consultation notes, and phone messages.  This is what the pile looks like at 8:30 AM.   It gets replenished throughout the day.  Every second that I'm not seeing patients, I'm either dictating notes or tackling the pile.  This is how I spend lunctime, too.  Every piece of paper has to be carefully read and reviewed.  Luckily, I have a fantastic PA (physician assistant- Hi Dorothy!).  If it wasn't for her, I'd be really in trouble.


So, if it takes me until the end of the day to return a call, this is why.  If you need a form filled out, don't expect me to do it instantly- drop it off in advance.  If you call the office and refuse to tell my nurse or medical assistant what you need to talk to me about and just say "I will only talk about it with the doctor"...well, you're going to have to wait to talk to me.  I will call you back, but the pile has to be tamed first.  So patients, please have patience.

Thursday, September 22, 2011

My Accessory Brain

"No, Mrs. Smith. I'm not texting on my iPhone during our appointment. I'm just using my accessory brain."

That's what I call the various medical references that I carry with me at all times. Most doctors have an accessory brain of some sort. For the most part, I need to use it to look up drug dosages or to do some calculations. However, my accessory brain has come a long way, baby! Here's my first one, dating back to my time as a third and fourth year medical student:


The book on the left is a house staff handbook, chock full of quick references and mnemonics.  Notice how well-worn it is- I got a lot of use out of it, and actually still occasionally look something up in it.  The one on the right is a Pharmacopoeia- a drug reference.  I also usually carried a Ferri Manual with me- this is a spiral bound book that's several hundred pages in length, but yet claims to be a "pocket manual".  I thank Dr. Ferri for my recurrent neck pain and poor posture.

After graduation, I went high tech.  At the time, high tech consisted of very primitive PDAs.  I had one called a Handspring Visor.  It had a whopping 2M of memory and was...large.  It also had this dumb little stylus that you had to use on the touchscreen.  I was always losing that stupid stylus.  However, it had the great advantage of being able to combine several medical references onto one device.

The handspring lasted a year or two, then I took my husband's Palm Pilot as a hand-me-down.  It was smaller and had more memory.

I then moved up to a PDA called a Sony Clie.  It had this neat swivel screen.  Most impressively, it was in COLOR!  Wow!  I got a lot of use out of my Clie- I'd say it lasted about 4 years, which is an eternity in the world of technology.

The problem is that the pockets of my white coat would still bulge.  I'd carry my Clie, cell phone, pager, and prescription pad all the time.  My posture remained stooped.  Therefore, as technology advanced, I moved with it.  First, I tried a Trio.  This combined my cell phone and PDA into one device.  I still carried a pager.  I hated my Trio.  Hated it.  To be honest, I don't even remember why I despised it so- I just did.  I probably had it for less than 6 months.  I then moved on to a BlackBerry.  That was better.  I used it for about 2 years.

And then...my love affair began.  It's a love affair with my iPhone.  We started our relationship in 2009, and we're still going strong.  All of my medical apps, my running apps, my email, my phone, e-prescribing...all in one cute, tiny package.  I'm not sure if things can get better than this, we'll see.

In the meantime, I'll be making future posts about my favorite apps.

And I promise not to text during an office visit.

Tuesday, September 20, 2011

Man's best friend.

Let's face it. It can be tough to get motivated to exercise.  Really, many of us would prefer to do just about anything other than exercise.  That's why I suggest getting a workout buddy.  It's pretty easy to come up with excuses as to why you shouldn't exercise, but it's a lot harder to use those lame excuses on a friend.

So, meet Indy.  He's my workout buddy.  We've been running together since 2006.  He doesn't care what the weather is like.  He always runs at my speed.  He never, ever, passes a chance up for a run.  His only downside?  I have to pick up his poop.  He also gets a bit stinky if we run in the rain, but hey, so do I.




So, if you're just getting started with a running or walking program and you're having a bit of trouble getting motivated, find a friend.  How do you do this?  You can check out this forum.  Or you can join a local running group.  If you live in my area, you can join my running group in the spring. Or, you can get a dog (but a friend might be better, since you won't have to pick up their poop).  Enjoy the companionship and the exercise!

Monday, September 19, 2011

Edible Rorshach Blot

Mondays are a tough day to blog.  I have evening office hours on Mondays, so I see patients from 8AM to 7PM.  It makes for a long day, and I don't have much energy left to put into posting.  So, here's a quick one.  I pulled this potato out of my garden this weekend.  I thought it was...interesting...to say the least.



So, what do you see when you look at this potato????

Sunday, September 18, 2011

Eat Your Veggies!

I remember when I was a perfect parent.  It was before I had kids.  Back then, I smugly thought about my perfect not-yet-even-conceived children.  They would never have tantrums.  They would never talk back. And, of course, they would eat whatever we put in front of them.  In fact, when Jessica Seinfeld published a book called "Deceptively Delicious"about how to sneak veggies into food, my husband Patrick and I rolled our eyes.  "Why not just teach your kids to eat vegetables?" we asked.  Our perfect children would not have to be tricked into eating healthy foods!

Well, not surprisingly, karma came and bit us in the butt.  Our older son, Alex, is 4 1/2 and is quite the picky eater- maybe even worse than I was at his age.  If he had it his way, he would subsist entirely on milk, mac and cheese, and Cheerios.  It's a constant struggle to get anything approximating a balanced diet into him.

Therefore, I was pretty excited when I heard about this magical vegetable called spaghetti squash.  Apparently, when cooked, it looks like noodles.  Your kid will never know the difference!  Well, I decided to put it to the test and make a Spaghetti Squash Casserole.

Here's the squash- for those of you not familiar with what it looks like (I actually grew these in my garden).


After cooking them in the oven and scraping them out, I have to admit it actually did look like pasta (or at least rice vermicelli).


After cooking it- here's how it looked (after some had already been taken out for the kids):



As for how it went over with its intended audience...well, let's just say the kids were not fooled for a minute.  They knew it wasn't spaghetti, despite my claims to the contrary.  Matthew ate it, but he eats everything.  Alex, with a lot of coaxing, actually ate about 2/3 of his portion- which is probably more vegetable than he's eaten in the past year.  I think, although he'll never admit it, he actually might have enjoyed it.  So, a success in my book!  I'll keep fighting the good fight...

Saturday, September 17, 2011

Why do you need a primary care doctor?

Why not see a specialist for everything?  After all, they're the experts, right?

Wrong.

It's vital for everyone to have a primary care physician.  Your PCP should always be your first point of contact with the medical world.  A good relationship with a good PCP can save you time and money, but most importantly, can save your health.  I'm going to tell you why...

An internist does more than diagnose your strep throat, take care of colds, and do your yearly physical.  Internists are specifically trained to take care of medically complex patients.  The most import skill an internist learns in medical school and residency is to create what is called a "differential diagnosis."  This is a list of all of the possible things that could be causing an illness.  It takes years of experience and practice to be able to develop a comprehensive differential diagnosis, but it's vital that your doctor be skilled in doing this.  Otherwise, important illnesses can be missed.

It's a bad idea to try to "self-diagnose" and then self-refer to a specialist.  Here's an example of a common scenario:

Let's say a patient, we'll call him Joe, starts to have some chest pain when he lifts things.  He doesn't have any problems that he knows of, but his father had heart disease, so he's worried.  His wife is also worried.  They go to see a cardiologist.  He has an ECG done, which is normal.  His cholesterol is also checked, and is normal.  Because he still has chest pain, the cardiologist does a stress test.  It's normal.  The cardiologist says, "Your heart's fine."  And that's it.  The cardiologist is done.  But Joe still has chest pain.

Now, let's say that Joe went to see his internist first.  The doctor gets a history and performs a physical exam.  The physical exam shows that Joe's chest pain is reproduced when certain areas of his chest are pressed.  The internist diagnoses Joe with costochondritis- an inflammation of the cartilage of the ribs.  He's treated with ibuprofen and the pain goes away.

What Joe needed in the first place was someone to look at the "big picture."  And that's what your internist does.  A good internist will be able to treat many, many things right away, but will be able to steer you to the appropriate specialist when necessary.

So, even if your insurance says you don't "need" a primary care physician, it's still important to have one!

Friday, September 16, 2011

Hey, I'm starting a blog!

If you're reading this, you're likely either my patient, a prospective patient, a friend, or my mom.  I've decided to start this blog to help my patients get to know me better.  Its secondary purpose is for people to find out more about primary care and the practice of medicine today.  Although I plan on posting a lot about medicine, I would also like to concentrate on other things that are important in my life.  My family, of course, has the top spot.  My hobbies, such as running, will be discussed, too.

Join me on this journey!  Feel free to comment, and I look forward to this adventure!

PS- Please excuse the current boring appearance of this blog.  I'm working on it...it's a learning process...