Could Your PCP Pick You Out Of A Line Up?

November 10, 2009 at 4:44 pm (Communication, Critical Thinking, Current Events, Managed Care, Medical Ethics, Patient Information, health insurance)
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DocBaker

I doubt mine could.  Which makes me think about Little House on the Prairie.  Anyone around in the 1970s remembers idyllic Walnut Grove, where Doc Baker took care of everyone and their pets.  He gave advice, dispensed medicines and sent the tough cases to Mancato (the big city).  People ran into him at the general store and he promised to stop on by the next time he was out their way.  To our modern ears, it sounds very quaint until you realize that this is the model of health care that we aspire to and were supposed to get with the onset of HMOs.  Under that model, we were each supposed to have a PCP who would monitor our health, give us lifestyle advice and send us to a specialist if any red flags showed up.  This would be the ‘gatekeeper’ (insurance term) that would be familiar enough with our health history that his or her decision would be one based on a long view of our individual health status.  Unfortunately, this model was managed to death by efficiency experts until it is neither efficient or effective.  The political choices we have before us continue this trend. Until we as patients demand better, the push will be for PCPs to do more with less.  In a recent poll (Investors Daily)  45 % of primary care physicians will consider quitting medicine if the government takes over the health care system.  That is approximately 360,000 doctors that will consider quitting practice.  Clearly, doctors are as frustrated as their patients.  Health care reform, to make any meaningful changes needs to redefine the role of doctor and patient.  The most efficient role the doctor can play is health coach in a proactive way.  That can’t be done in 5-10 minutes once a year. Or with a quick blood test.  Patients that are empowered by their relationship with their doctor will make the most beneficial (and coincidentally, the most cost-effective) changes to their own health.  In that climate, there will be less of a role for bean counters and government pencil pushers.  Let’s not give up the idea of Doc Baker too quickly. 

Dr. Michalene Elliott is a chiropractor in Rochester, NY who doesn’t want to be managed anymore.

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What’d Ya Say? Divided By a Common Language.

October 27, 2009 at 4:13 pm (Chiropractors & Chiropractic, Communication, Critical Thinking, Evidence Based Medicine, Patient Information)
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applesoranges

The importance of using common language when communicating about back pain has been well documented in the medical literature. There are three main areas that lead to difficulties in communication about back pain:

  • patients seeking information from health care professionals can experience difficulties understanding them and the medical literature
  • misunderstandings among health professionals concerning terminology can arise
  • lack of standardized definitions for back pain terms can make comparison of research studies problematic

A study just published in the BMC Musculoskeletal Disorders aimed to explore the meanings and issues surrounding the use of existing medical terms for back pain from the perspective of health care professionals and lay people. Focus groups were used to explore participants’ understanding and samples included general practitioners, chiropractors, osteopaths, physiotherapists, and lay people.

Lay participants understood the majority of the terms explored in the group differently than the health professionals. Some terms were not understood, some misconstrued and some had inadvertent negative connotations or implications. (For example “wear and tear” instead of the harsher term “degeneration” gave implications of wearing away or rotting).   The commonness of misunderstandings, unintended meanings and negative emotional responses to terms used in this study have a number of implications.

Firstly, it must encourage providers to ensure their patients understand what has been explained to them including the contextual and emotional implications. Secondly, patients and providers should have an ongoing dialogue to promote understanding of terms and comminality of language.  Third, this study should be used as a lesson to chiropractors who cling to old, antiquated terminology that we know has differing meanings both intra- and interprofessionally. If other chiropractors cannot agree on a term’s meaning, and other professions cannot agree on that term’s meaning, you can sure as heck bet that your patients have no idea what you are taking about either.

I was recently told that we should take antiquated terms and reframe them so we can continue using them in a different context. To me, this study implies that is not a wise course of action.

 

Brett L. Kinsler, DC is a chiropractor in Rochester, NY who avoids using antiquated terms when he blogs at www.RochesterChiro.wordpress.com

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The Autism Panic!

October 15, 2009 at 8:46 pm (Autism, Evidence Based Medicine, Vaccination)
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panicThe sky is falling!  The sky is falling!

Wait, what?

Oh, sorry. 

The sky is rising! The sky is rising!

Wait, sorry.  What now?

Oh, okay. 

The autism rates are rising!  The autism rates are rising!

Alright kids, let’s go over this again.  Autism rates, really the autism spectrum disorder (ASD) rates, are on the increase.  You’ve heard the new 1 in 100 number quoted, right?  I’m not saying that’s inaccurate.  It’s just that there is no real increase represented.  How can that be? Clearly something (or someone) must be to blame for this terrible condition.  Who can we hang?  Quick, after them!

There were two recent studies concerning the prevalence of autism in the US that have attracted a lot of attention.  One study conducted by the CDC (not yet published) reports that the new prevalence of autism spectrum disorder (ASD) is now estimated at 1% or 100 in 10,000 children. This is an increase over the last few years. In 2002 the prevalence was estimated to be 66 per 10,000 (0.66%).

The second study published in the journal Pediatrics was a telephone survey of parents where they asked if they had any children who had ever been diagnosed with an ASD.  This non-clinician scored study estimated ASD point-prevalence at 110 per 10,000.  These are slightly higher numbers than the CDC data but that is to be expected, since diagnoses from the phone survey were not confirmed by a doctor.

There is no argument that the number of ASD diagnoses has been steadily increasing for the last 20 years. The real question is whether or not the increase is  a true increase in the disorder or an artifact of increased surveillance and an expanded diagnosis.  Without a doubt, the evidence strongly supports the conclusion that the increasing autism prevalence is due to increased efforts to make the diagnosis and a broadening of the definition of autism. The evidence is not sufficient to conclude that there is not also a real increase in ASD incidence, but nor is there data to support this conclusion.

Recently, more data have come out of the National Health Service (UK) that looked at a very interesting statistic.  They looked a the prevalence of ASD in adults.  See, if there is a true rise in autism, the adult population should have a lower number of cases than the current children.  Guess what?  1% across the board.  Kids and grown-ups.  Oops.  Sorry conspiracy theorists, move it along…nothing to see here. 

What can be concluded is that 1% is likely close to the true prevalence of ASD in the population.  And, the strong evidence points to the lack of an increase ASD rates.  Let’s continue to use good science to get to the bottom of ASD and not sheer panic and anti-vaccination finger pointing.

 

Dr. Brett L. Kinsler is a chiropractor in Rochester, NY who blogs at www.RochesterChiro.wordpress.com

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Quantum Light Weaving

October 7, 2009 at 7:39 am (Alternative Medicine, Evidence Based Medicine)
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quantumhealing

“Tell me, Doctor, what do you think of Quantum Light Weaving?” my patient recently asked me.

“What do I think of what now?”

“Quantum Light Weaving.”

“You’re putting me on, right?”  My patients know I will usually express my opinion on most things that are wacky and some of them try to get me to take their bait.

“No, it’s a real treatment.  I saw it when I was in California.”

“You’re setting me up for a blog post, right?”

“I have no idea what you’re talking about.  Have you heard of it?”

Well, to be honest, I hadn’t heard of it.  I was almost certain it was something made up and silly.  Light weaving?  Really, now?  I have a friend who was a pretty serious weaver for a while.  I was nearly certain she used wool and fabrics.  Very, very rarely would she weave pure energy or electrons.  Nope, something didn’t smell quite right.  I promised to investigate and get back to this sweet young patient with an opinion.

I performed my usual deep level of research which can be partly reproduced for you by clicking this link.  I learned some amazing facts — and by “amazing” I mean “silly” and by “facts” I also mean “silly.” Quantum Lightweaving is, according to the experts (“salespeople”) ”an evolving and ever-expanding body of work that is bringing forth new aspects of spiritual work that embodies The Christos energy from the heart of Creation itself. The vibration is brought forth to this earth and Galaxy through The Council of 14 and your personal healing and support team of masters and angels.”

Okidokie then.  We’re got ancient Christian and presumably Last Supper stuff mixed with galaxy energy and personal support teams of masters and angels.  Hell, I can’t even put together a team that includes a decent plumber, how am I going to get an angel on such short notice?

Have no fear!  Your personal guide is Kenji who teaches you “how to be a miracle man, miracle woman, miracle kid and miracle pet.”  Miracle pet, huh?  Whoa.  Deep, dude.  And for only $25 to $50 there is an assortment of attunements you can download right to your computer.  You can even use your mystical Paypal account!  Let the miracles begin!

Well it all makes sense when you learn that “when we align through the meditative state, or “hook-up,” miracles beyond time and space and distance can occur in the twinkling of an eye.”  Wait…hook-up?  Do they really use “hook-up” to describe a state of being?  How is your hook-upedness today?  I am attempting to achieve the 9th level of hookopcity. Can I hook up my angels to my masters?  Do I need a special adapter? Will that create a miracle pet?  Will my miracle pet still puke on the carpet?

“Lightweaving affects all 144,000 dimensions of your being, or the 12 major levels of your embodiment.”  Awesome.  Lately, I have only sensed like 120,000 dimensions but I thought it was just the weather.  I feel enlightened.  I feel empowered.  I have seen the quantum light show and now know the true answer.  Quantum Lightweaving is…just…another magical way to separate people from their money.

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Health Insurance Crisis? Solved.

September 24, 2009 at 12:40 pm (health insurance)
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cone

Don’t panic.  I may have done it.  Yes, your friendly chiroblogger may have accidently solved the national healthcare crisis.  I found an existing health insurance company that provides comprehensive health coverage for under $40 per month.  And this isn’t just some catastophic Roadrunner gets smushed by a falling safe and winds up in traction kind of coverage.  This is really good.  Really, really good.  Just look at these benefits:

Illness – Covered
Injuries & accidents – Covered
Hospitalization – Covered
Surgery – Covered
Hereditary conditions – Covered
Diagnostics – Covered
Prescription medications – Covered
Vaccinations – Covered
Annual Exams – Covered   
Dental Scaling/Polishing  – Covered
 
Wow!  Prescriptions?  Dental cleanings?  They even include some elective surgical procedures.  For forty bucks a month?  There aren’t even any copayments!  I’m awaiting the phone call from Obama any second now.
 
This just may be the ticket the country is waiting for. 
 
Now, there are a couple of exclusions.  There’s always fine print, right?  Okay, the following are not covered: parvo, distemper, kennel cough, heartworms and feline leukemia.  And grooming, bathing and dipping are out too.  Other than that, PurinaCare seems to provide a pretty darn good health insurance for a really reasonable price. 
 
Crazy, right? Dogs and cats get high quality health insurance while their owners are left to be ill.  What’s in it for we, the people?  A lot, according to the North American Pet Health Insurance Association (NAPHIA). 
 
According to recent studies, the NAPHIA figure the health benefits of  pet ownership  include:
  • Reduced risk of cardiovascular disease
  • Higher survival rates from heart attacks
  • Significantly lower use of general practitioner services
  • Reduced risk of asthma and allergic rhinitis in children exposed to pet allergens during the first year of their life
  • Better physical and psychological well-being for seniors

    • Interesting.  These are pretty tangible preventative health benefits.  I may have solved the health insurance situation after all.  I mean, obviously the pet insurance companies won’t cover people.  But if the benefits of pet ownership are so great for health, I might just start instructing my uninsured patients to take two kittens and call me in the morning.  Problem solved.

    Next?

     

    Dr. Brett Kinsler is a chiropractor in Rochester, NY.  He is insured but his cat (favorite hobby = peeing in corners) has no coverage.

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    This is why you’re marginal

    September 7, 2009 at 9:40 pm (Chiropractors & Chiropractic)
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    chiroad2009

    We are fairly insulated in Rochester from sleazy, totally unprofessional chiropractor advertisements.  They occasionally pop up like freaky little mushrooms and usually get stomped on rapidly.   Here’s one that appeared in a local fishwrapper this week.  Let’s have a little contest – how many unprofessional, insulting or just plain factually incorrect items appear in this ad?  Keep in mind the total ad has less than 100 words!

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    Up the Nose With a Rubber Hose

    September 3, 2009 at 9:35 am (Evidence Based Medicine, Inventions, Patient Information)
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    balloon_nose

    Sinusitis is an inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.  There can be pain and nasal congestion.  Acute sinusitis often follows a cold, but chronic sinusitis can last for extended periods and make people miserable.  More than 30 million Americans suffer from chronic sinusitis, meaning symptoms last longer than two months or regularly recur. Patients repeatedly try antibiotics, decongestants or steroid-containing nasal sprays, but about a quarter are thought to get inadequate relief.  Sometimes, surgery is the best option for chronic sufferers.  Standard surgery involves cutting away bone in the sinus cavity to open the passage way and allow drainage.

    This week, a patient asked me about a procedure where they stick a balloon up a patient’s nose and inflate it in order to ‘move the skull bones’ and help with sinus problems.  I thanked him for the idea for a blog article and began to do my research on what I was sure would turn out to be some wacko in a clinic in California (why is it always California?) sticking things up people’s noses and declaring them “Sinus Free!”

    Instead, I got educated on a new alternative to the standard sinus surgery.  Balloon Sinuplasty is compared to angioplasty — you know the procedure where a catheter is fed through an artery and plaques are squeezed to the sides with an inflatable balloon.  With the sinuplasty, the catheter is inserted into the sinus cavity and inflated to open the passageway and promote fluid drainage and pressure reduction.  Inflating the balloon aims to stretch the sinus opening back to its original size or little bigger, thus letting air (and antibiotics) into the sinus.

    The research looks promising for this technology and it is most certainly not a novel means of cranial adjusting as I initially suspected.  Whew.  Patients who have the balloon catheter procedure appear to have significant improvement in symptoms two years after surgery.

    The best part is that the research generally scores patient symptoms using my favorite clinical instrument:  the SNOT – 20 which I discussed in a previous post.

     

    Dr. Kinsler is a chiropractor in Rochester, NY.

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    Servings per container: 557?

    September 1, 2009 at 8:57 am (Critical Thinking, Nutrition, Skepticism, Vegan & Vegetarianism)
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    cookingspray

    One of those people with a good sense of the absurd?  Here is something absurd that’s probably right in your kitchen.  Get out your favorite brand of cooking spray (found in almost all American homes) and check the serving size.  Chances are, it will be somewhere between 0.25 and 0.33 seconds.  That’s between 1/4 and 1/3 of a second.  The servings per container will be between 350 and 600. 

    This is a perfect example of why we have such a problem with achieving health in this country.  No, not cooking spray.  Misleading information presented as fact.  Maybe somewhere, in some test kitchen, a trained professional can spray for only .25 seconds but everyone I know really wants to coat that pan with ‘non-fat’ cooking spray.  Problem is, used the way most people really do, it is not non-fat.  In fact, it is oil.  Pure fat. 

    For comparison, a can of cooking spray is about 6 ounces. A stick and a half of butter is 6 ounces.  Imagine cutting that stick and a half of butter into 557 pieces.  Now, spread one on your toast.  Congratulations, you have just had ‘fat-free’ butter.

    We have been led to believe that non-fat cooking spray is much healthier than oil.  So which is better?  Well, one comes in a spray can with propellants.  At least with the pure oil most people would try to be judicious. 

    In fact, if you are using non stick pans, then the cooking spray is redundant.  If you are trying to cook with no fat, it would be preferable to cook  just with broth or water.  Yes, you really can sauté in just plain water.  I prefer broth or wine for flavor but water works just fine.  Plus, it’s free –no spray can needed.

    Dr. Michalene Elliott is a chiropractor in Rochester who writes for RochesterChiro’s blog and has tried to spray for less than half a second but, sadly, cannot.

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    Medpedia News and Analysis

    August 29, 2009 at 7:45 am (Shameless Self-Promotion, Website Recommendations)
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    badge_text_tallI like Wikipedia as a shortcut to quick information but I am afraid to use the information there for any serious projects.  After all, the people producing and editing the content there are just average Joes.  Sure, if you put together enough average Joes and solicit their opinions, you are more likely to come to an accurate conclusion…sometimes.  Not exactly a bet I’d want to place.

    Wouldn’t it be cool to have a wikifor medical information where only verified medical professionals can directly edit the material?  There is so much medical misinformation on the internet it would be nice to have a source that is more apt to be responsibly written.

    Medpedia looks like it might fit that description.  Still in beta phasebut set to fully launch soon, the Medpedia Project is backed by Harvard Medical School, Stanford School of Medicine, Berkeley School of Public Health, University of Michigan Medical School and other leading global health organizations. The goal is to create a new model of how the world will assemble, maintain, critique and access medical knowledge. Over time, they expect to have a collection of up-to-date unbiased medical information, contributed and maintained by health experts around the world, and freely available to anyone who is interested.

    This week, I was contacted by a Medpedia staffer. They requested permission to put my blog posts onto the News & Analysis section on their site.  I am pleased and proud to be among the bloggersinvited to participate and welcome the new Medpedia readers and their comments.

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    Instant heart attack – just add bacon. Oops, too late.

    August 24, 2009 at 5:11 pm (Current Events, Nutrition)
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    Turns out meat is the new bread.  Thanks to a loyal blog reader for alerting me to this all-in-one vegan nightmare, cardiology freak show and only in America culinary death missle that virtually punches you directly in the organs.  KFC introduced in several test markets their “Double Down” sandwich.

    This “sandwich” consists of two deep fried chicken fillets wrapped around bacon, cheese and some type of sauce.  The chicken is the bread.  You heard me — instead of  bread, they use two pieces of fried chicken.  Even Robert Atkins would push this away as being just a bit too meaty, dontcha think?

    The name, “Double Down” (which won out over ”Double Bypass”), is linked to the chances of developing heart disease during that meal (easily doubled).  And, after signing the required medical release form KFC requires,  you can listen carefully and actually hear your own arteries hardening.kfc-doubledown

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