Each One Reach One

Trail runners are a friendly bunch.  Being crazy enough to wake up before dawn on Sunday to run eleven miles over hilly, root-ridden trails creates a special bond.

On this morning’s run, I met a college freshman who wants to be a primary care doctor.  He told me we could reduce the cost of health care by treating patients via email and the internet.   While some patients need to be seen regularly and some conditions diagnosed in person, other patients can be treated via email with an annual face-to-face visit.  I was proud to tell him that I email my patients regularly and send prescriptions electronically via a secure patient portal.

This college student’s perceptive statement impressed me.  I realized I have become so enmeshed in health care that I have forgotten how  closely folks outside our professional family follow these issues.  To a generation that has grown up with email, text messaging, and social media, the question isn’t why should we communicate electronically, but why shouldn’t we.

I spent the next twenty minutes selling him on family medicine.  I told him about the variety of patients you see and how you can use state of the art technology to communicate with and treat patients.  I can  look up the current treatment of malaria in a young adult who recently returned from a family funeral in west Africa, then send an email to make sure the treatment worked.

Today’s college students may not choose family medicine for the same reasons I did, but I want them to see that they can use cutting edge information technology to communicate with their patients, treat a wide variety of medical conditions , and focus on different areas of interest as their careers and views evolve.  We have to show the next generation how fun and satisfying family medicine can be.

 

HOW CAN YOU REDUCE YOUR CHANCE OF GETTING COLON CANCER

Colon cancer is the 3rd most common cancer in U.S. men and women. It is the 2nd most common cause of cancer death. While some people inherit a higher risk for colon cancer, most people who get colon cancer have no family history of the disease.

Exercising, quitting smoking, and controlling your cholesterol and blood pressure lower your risk of a heart attack, but reducing your risk of colon cancer is not as easy.

You may see news on the Internet or television about the latest thing that will prevent cancer. Proving that certain foods, vitamins, or minerals cut your risk of colon cancer takes a lot of research. We need several studies to agree before we know what will help you.

When I talk to my patients, I want them to know what works, what doesn’t work, and where we need more research.

May lower your risk (but needs more research)
• Diet
o Eating less fat
o Eating less red meat
o Eating lots of fiber, fruits, and vegetables
o Eating garlic
• Lifestyle
o Avoiding excess alcohol
o Quitting smoking
o Regular exercise
• Vitamins, minerals, and medicines
o Calcium
o Vitamin B6 (high doses)
o Vitamin D
o Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs)
 They can also cause stomach and intestinal bleeding, so you should talk to your doctor before you try them
o Metformin (diabetes medicine)

Does not lower your risk
• Beta carotene
• Folic acid
• Vitamin A
• Vitamin C
• Selenium
• Statin drug (cholesterol lowering drugs)

Increases your risk
• Obesity (having a body mass index for 30 or more)
• Vitamin E

The best way to avoid getting colon cancer is to get screened by your doctor.

The Cost of the Doctor’s Pen, Part 2: “We have met the enemy and they is us”

Where doctors go for their fountain pen fix – Houston Chronicle

Pogo was right.  When we complain about the burden of insurance company paperwork and inadequate reimbursement by Medicare, we have to look at ourselves too.

Many factors drive the rising cost of health care. These include overuse of medical tests, repeat hospitalizations for chronic conditions like heart failure, excessive emergency room visits for conditions that could be treated by primary care doctors.  Just as we must think about the cost of each medication we order when we sign that prescription, we should consider our personal decisions and the perception it creates in the public eye.  If we want to claim the moral high ground, our personal habits must reflect the ethics we claim to practice.

Exercise Is Bad For You

“I told you exercise was bad for you,”  Mr. R called out as my wife wheeled me into the clinic.

Busted.  “I’ll never live this one down,” I thought.

Early that morning, I stepped off a curb while running and felt a sharp pain in my foot.   X-rays showed a 5th metatarsal fracture.  No weight-bearing for 6 to 8 weeks.  Boo.

I have been physically active as long as I can remember.  My parents enrolled my brother and me in every team sport our community had.  While my lack of hand-eye coordination made basketball and baseball challenging, I loved to swim and play soccer.  When I discovered running in high school, I found my true love.

After 28 years, 11 marathons, and 5 ultramarathons, I suffered my first running related fracture.  Overuse caused my previous injuries, but this one was random.  I ran that route every day.  I have stepped off that curb a thousand times.

So I put my foot in a walking boot and bought crutches.  Having never used them before, I had no idea how hard using your arms and one leg for locomotion was.  I lost 5 pounds and had to stop wearing my usual long-sleeved shirt and neck tie.  Forget the white doctor’s coat, that was like working in a sauna.

My patients got a real kick out of my predicament.  Everyone I have nagged for years now had the perfect counterpoint to my pleas to increase their activity.

“You’ll lose weight, your blood pressure will drop, and your blood sugar will plummet”

“Yeah, but look what happened to you.”  Touché.

The words of a colleague came back to me:  “But you LIKE to exercise.  Most of your patients don’t.”

So how do I motivate someone to do something she doesn’t like to do that might hurt her?  Scary statistics about heart attacks don’t motivate you to head out the door when it’s raining.  I have to find out what motivates you:  losing weight, looking better, or reducing stress.  I have to help you overcome your barriers:  the weather is too hot / too cold, the sidewalks are bad, my knees hurt, my neighborhood is not safe, my appearance embarrasses me.

So for Mr. R, I know we connected as doctor and patient because you are comfortable busting my chops.

And you know that I will keep trying to get you out that door and down the sidewalk.