Why Your Doctor Needs Your Help
Your doctor needs your help urgently.
Almost anyone who has ever been a patient waiting in a physician=s office has direct reason to know that doctors need help. Why is it a common experience routinely to have to wait for an hour or more to see your doctor? The reason is because they can=t get it all done in the time allowed. They can=t get what they think is important done, and often they can=t get even what you think is important done. Why not?
There are two basic reasons. One of them has to do with you. Often you are not prepared to make the most use of strategically important time with your physician. Many patients either have a list of 4-7 things they want to talk about (it is pretty routine to have at least 4 problems once you hit the age of 55 years), and doctors just don=t have enough moments in a 15-minute visit to address so many issues. This is why it is absolutely critical that you be prepared, have a specific agenda, and know your own priorities for that 15-minute interaction. This, of course, is what this article is about. In subsequent articles I will help you plan a very specific agenda for your physician for that 15-minute visit.
The other reason is that doctors generally are blindly trying to follow the advice of various experts in determining how much attention to give each problem. Doctors have an endless set of authorities to whom they defer to help make most of their basic decisions: how many pieces of data to ask you about, how much of a physical examination to do on you, how many tests to order, how many and which prescriptions to write for you, and how soon and how many times to see you again after this visit. The problem is that they have to do this for each of the problems you mention to them. Thus, even if they cut out all the chit-chat (that makes your personal to you), they run out of time half way through the second problem. If they chit-chat, then they barely get the first problem taken care of. It is up to you to determine the appropriate level of chit-chat. It is always a trade-off between getting specific agenda items handled properly and being able to share bits of yourself with this fellow human being. Sometimes absolutely the right thing to do is to just drop all task-related agenda items and talk about your concernsBanxiety, depression, sleeplessness, social embarrassment, difficulty with the kids or your spouse. But this is a decision for you to make, not for your doctor.
In order to grasp the absolute need for you to take control of the agenda in the doctor=s office, you need to understand the nature of the pressure he=s under. Let me try to explain it this way.
You expect your doctor to be able to take care of your chronic health problemsBlike asthma, high blood pressure, diabetes, heart disease, etc. Right? If he doesn=t, who else would? And you also expect her to advise and implement preventive health measures that might be beneficial to you. Right? And, finally, you probably have some specific concern, something not right, that prompted you to schedule this particular visitBwhat physicians call your >chief complaint.= Here=s the dilemma, as presented in a few important studies over recent years.

In a study reported in the Annals of Family Medicine in 2005, investigators attempted to determine how much time it would take an average physician to care for 10 of the most common chronic diseases he sees daily in his office if he followed various expert guidelines published which define quality care for these diseases. The striking answer produced by this study was that it would take 10.6 hours per day just to take care of this handful of common chronic diseases. This answer was reached merely by adding up all the number of expert-recommended visits, assuming a standard 15-minute visit, for these 10 problems in varying degrees of control from stable to actively progressing or deteriorating.
To take an example that I have experience with, consider the management of a patient with diabetes. In 1998 the American Diabetes Association, the recognized expert in its field, published a AStandards of Care@ for the management of patients with diabetes. Their guideline recommended over 30 different, complex pieces of historical information be obtained for all patients at the first visit, that a full physical and neurological exam be done, then about a dozen laboratory test results to review or order, and then extensive patient education both about the disease and about the medications given. A reasonable estimate of the time to do this adequately would be 2 hours. Some specialists (endocrinologists) in private practice may actually have 2 hours of time to spend with a new diabetic patient, but no one I know in primary care, where 90% of all diabetes care goes on, has ever had this amount of time.
In order to try to put a practical face on these recommendations, I convened several focus groups of family physicians in south central Pennsylvania (a rural area where primary care physicians do most of this work). When describing their own experiences, these physicians reported that they were lucky if they were able to spend a half-hour with a new diabetic patient; they reported the frequent experience of making this diagnosis incidentally in adults in the middle of evaluation for another problem and trying to cover the basics in only 10 minutes.
Diabetes is probably the most complicated disease that primary care physicians manage, and good care requires regular systematic coverage of over a dozen issues. These physicians, at least as confided in my focus groups, would love to have an authoritative guideline that was short, simple, and focused on the critical aspects of care. That=s not what they get from the experts. Instead they get a completely untested, impractical, overly elaborate set of recommendations that simply have no place in the real world. (In fact, even at the time of this writing there has never been any study that showed either that even specialists used these guidelines or that anyone was able to achieve better outcomes by using them.)
In this column in future articles, I will tell you exactly what you need to know to take superb care of your diabetes. It=s very doable, and it=s very important. Few diseases do as much damage as diabetes does, if it is not managed well.
Returning to my point of how little time your doctor has, I want you to be aware of a similar study by some of the same authors in the American Journal of Public Health in 2003. There they analyzed how much time it would take general physicians to comply with standard preventive medicine guidelines. In an effort to make the task more manageable, they decided to look at only the top half of more than 169 different potential preventive interventions Bthe ones that had the best scientific evidence to support their benefit. They performed a time-motion study in physician offices recording the actual amount of time spent doing the recommended interventions. The surprising result here is that they determined that it would take 7.4 hours per day just to carry out the top 50% of all recommended interventions.
Thus, it will take your doctor 18 hours a day to handle the minimum expected medical standard of care. Mind you, this is without considering whatever amount of time it will take to address your >chief complaint,= typically a cold, or bladder infection, or muscle sprain.

The bottom line is that there is no way it is all going to get done. This is the fact of modern medicine. It presents a dilemma for every one. Doctors become disillusioned and frustrated by their inability ever to get it all done and by the perpetual experience of having to accept so much less accomplishment than they aspire to. Patients are continually frustrated (and occasionally sue) because a lot of very important issues never get adequately addressed. The health care system (if it can be called that) in the U.S. just tolerates this grossly inadequate status quo. According to one expert in the August 2006 New England Journal of Medicine, there is no major impetus on the current horizon to address this issue.
This is the very problem that this column will help to solve. Without a gargantuan effort by scientists, academicians, and politicians, nothing else will solve this problem for you. And, even if such an effort was commenced, it would, of course, will take years to bear fruit. The best recent example of a health care project of similar magnitude was the fate of the Clinton proposal for national health insurance, and you remember what came of that.
So you=ve got to do it. There are two basic means of insuring your own healthBwhat you do for yourself and what you do with your doctor. This column discusses both of them. What you can and should do for yourself without your doctor, however, is quite simpleBreally no more complicated than--30 minutes of exercise daily, 5 servings of fruits and vegetables daily, and avoiding obviously toxic substances like cigarettes, excessive alcohol, and illicit or excessive prescribed drugs; these need not take up a lot of our time. The major portion of this column will be devoted to very specific details of what you need to know and need to ask your physician to do for you in the context of your personal, specific health care needs and preferences.
The other exciting and reassuring result of modern medical research is the information that many chronic diseases, like diabetes for example, are much better managed, and with more favorable results when patients take over management of their own care rather than when physicians do it. This is a very important piece of new research information which we need to try to understand. There is already some supporting evidence to demonstrate that, if you take charge of your own care, as I suggest, you will achieve substantially better results. We will look later at some of this research in detail.
To give an example of how your role begins, you can start with the unmanageable list of 169 potential interventions. Fortunately, only a very few of these will apply to you. So all you have to do is to prescreen the list and, based on your age, gender, and situation, you can pick the handful that apply. I will give you some specific guidance on the ones that have the highest value to insure that you limit your list to a feasible number. Remember, you are only selecting your highest priorities, because there is only time to do so much in a visit. (It is a perfectly valid strategy to schedule a follow-up visit specifically to include more of these preventive services, but don=t try to get too many into a single visit. That=s just frustration for everyone.)

The second job for you is both easier and more difficultBdealing with any chronic health problems. It is easier because you know what health problems you have, and you just don=t have to bother with any others (and, in general, don=t let your doctor go off on tangents and screen you for diseases you=re not concerned about them; they tend to do this because of certain biases built into the healthcare system, which makes them (not you) feel better when they do this). Your job is to stay focused.). It is harder because you have to master a small amount of very specific information that will give you a handle of your own disease. For example, if you have high blood pressure, it=s worth knowing that family history is not important (i.e., don=t waste time on it). The most important part of the general history is to review the complete set of heart disease risk factors (age, gender, smoking status, high blood pressure, diabetes, lack of exercise, metabolic syndrome, cholesterol, and renal impairment, and family history of heart disease [not of hypertension]). The physical exam (except for the measurement of blood pressure) is unimportant (so don=t waste time on it; the experts love to have your doctor do time-consuming, useless, and awkward things like looking into your eyeballs with a light and listening to your heart, etc.). Treatment is simpleBall patients should start first with a mild diuretic (called a >thiazide=, like hydrochlorothiazide (HCTZ)) and second with a drug called an ACE-inhibitor (like Vasotec, Lisinopril, Accupril, Benazepril, etc.; it doesn=t matter which one; just go for the best price in your drugstoreByou have to ask your pharmacist. Your doctor will usually not know [prices change so fast, and he has just got so much else to keep up with]). The goal of treatment is to keep your blood pressure below 140 mm Hg over 90 mm Hg (< 140/90 mm Hg). Measurement at home or at your pharmacy or supermarket is generally more reliable than measurements in your doctor=s office (mainly because we all tend to get tense in the doctor=s office; if you follow the recommendations in this book, you should be able to feel a lot less tense too!). If your blood pressure is below that level, it is enough to come in for a check-up and medication refill every 3-6 months; if it is not, you should plan more frequent visits, medication adjustments, and lifestyle adjustments involving diet and exercise.
OK. On to the real work of becoming an informed patient who can really help your doctor. Let=s start with some general principles of good health in our next few columns. I hope I can illuminate a few nuances and provide the specific reassurance that there is nothing more important that you can do for your own health.


Candida- An Introduction
Many people suffer from an excess of candida in their bodies, and sinus problems are among the effects. The yeast (a form of fungus), is called candida and the disease is referred to as candidiasis. If you feel listless, achy, or even light-headed or “spacy”, in addition to having sinus and other health problems, you many have an excess of candida.
Candida can flourish in the body when the immune system is impaired. The disease is often a result of taking too many courses of antibiotics or other medications that can harm the immune system. Dr. Robert Ivker, in his book “Sinus Survival” states “What I have repeatedly observed in my practice is that the vast majority of people with chronic sinusitis, who have taken three or more ten-day to two-week courses of antibiotics within a six month period, probably have some degree of candidiasis.” Certain hormones can also contribute to the disease, including those in birth control pills, as can cortisone medications such as prednisone. A high-sugar diet can also help the growth of candida, which uses sugar as a food. Diabetics have a higher than normal propensity for having candidiasis.
Unfortunately there is no easy test that can be used to determine if one has the disease, and many people tend to diagnose the problem themselves after numerous visits to a doctor, who cannot diagnose exactly what is wrong with them. Many candida sufferers are told “it’s all in your head”. There is a simple test of spitting into a glass and observing the mucus and how it dissipates. This seems rather folkloric, but there are usually grains of truth in folklore. Certainly this would not constitute a definitive diagnosis, but it might give some people an indication. This test is easily found on an internet search with the keyword, candida. Oftentimes the best diagnosis is to set out on a course of treatment to see if there is improvement in the patient’s conditions. Background questionnaires are also commonly used to determine probability of the presence of candida. If this seems possible and one has a number of the symptoms, it would make sense to seek out a physician or specialist who has extensive experience in treating fungal diseases.
Sinus problems are only one of the many issues that are confronted with candida. When candida spread throughout the body they tend to congregate in moist mucous tissue in the lungs and nasal areas, so sinus problems are often a result of candida. Other symptoms include sluggishness and a feeling of being “spaced out”, irritability, depression, mood swings, as well as itching and burning sensations when urinating. Diarrhea, cramping or constipation, and of course stuffy or runny nose and sinus infections are also experienced by candidiasis sufferers. Also noted as symptoms are cravings for certain foods, such as breads, sugars, cheeses, and alcohol.
Treatment is not simple and generally consists of a “candida” diet. This diet is high in protein and vegetables and low on carbohydrates. It must be difficult to maintain this type of diet for extended periods. The diet aims to take away the fuel needed by candida to thrive. There are products available on the internet that claim to help candida patients, and one should research these thoroughly before taking them. Certainly one should obtain a doctor’s opinion before taking some sort of supplement. One could even try to personally contact people who have given endorsements for the product. Some of these are not very expensive, however, and the cost of trying them, given approval by a doctor, might be worth the cost and effort. Sinusitis in itself is a difficult problem to live with as is well documented at Post Nasal Drip, but candida sufferers must endure other health issues as well. Many of these supplement products and more information can be found easily by doing an internet search for “candida” or “candidiasis”.


OmniMD Electronic Medical Record (EMR) Software Integrates Modules & Services
OmniMD Electronic Medical Record (EMR) Software Integrates Modules & Services


Tarrytown(NY)—Oct 11, 2006-- OmniMD, a developer of HIPAA compliant EMR(electronic medical record) solutions has launched its new release, with wealth of new features, modules and services making it one of the most comprehensive integrated EMR and practice management solutions in the marketplace.
“Our primary focus in the new EMR release has been to eliminate bottlenecks in the clinical workflow and information management.” said Divan Da’ve, CEO of OmniMD.
The new EMR release is based on input from the present users of the system who consistently stress the need to create a common platform for the work processes of the medical office. “Our aim is to make OmniMD’s complete suite of products a one-stop solution for the practice and the physician.” said Mr. Da’ve
OmniMD Integrated Electronic Medical Record and Practice Management system is a broad solution for a medical practice combining in a common package all of the most important information requirements: EMR for clinical documentation, Integrated medical billing and practice management , Document Management for patient reports, Appointment Scheduler for appointments, to name a few. All these modules work together smoothly to streamline all aspects of the clinical workflow.
Here are some of the main modules available
Automated Patient Reminder, an interactive voice technology that automatically calls and reminds the patient of appointments automatically updates the OmniMD Appointment Scheduler with the patient’s response. The result: reducing no-shows while saving the time and effort of calling and confirming each appointment.
Online Patient Eligibility is an online process for a quicker and more accurate check of a patient’s insurance eligibility, to avoid costly billing errors and claim denials. OmniMD provides real time as well as batch mode online checking for insurance eligibility across commercial and non-commercial insurance payers. Insurance eligibility can be verified through a single point access to all insurance players.
Point and Click EMR System: The new enhanced OmniMD EMR system allows providers to generate consistent, complete and accurate clinical documentation, by selecting variable terms from pre-structured or customized point-and-click templates. The Point-and-click system generates many clinically reports, such as health maintenance reminders, history, physical examination, tests, diagnoses and therapy. One of the major advantages of template based charting is the time needed to make the document available as a medical record. Since notes are created within the EMR, they are available immediately upon completion.
Integrated Billing Services and Practice Management System: OmniMD has introduced medical billing services to combine with electronic medical record and charge capture software as a part of its suite of products and services. Trained billing professionals at OmniMD provide these services and manage the complete billing operation so that claims are filled out accurately with charges entered at the point-of-care OmniMD’s using charge capture software. Claims are submitted to the payers in less than a day, instead of the usual 2-3 days, resulting in faster payments and increased cash flow.

These new features are fully integrated with OmniMD’s other features including Appointment Scheduler, Charge Capture, Prescription Writer, Referral Management, and medical transcription. As a result, OmniMD is one of the few vendors providing a comprehensive set of products and services to the medical practice.

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About OmniMD
OmniMD is a developer of HIPAA compliant enterprise healthcare practice solutions, designed to fully automate the work-flow of contemporary healthcare organizations. The company is a division of Integrated Systems Management, Inc. (ISM), (www.ismnet.com) a leader in Internet consulting and e-business development since 1989.
OmniMD's suite of products and services empowers hundreds of clinics with the ability to efficiently automate and manage clinical processes and patient information electronically. With its comprehensive and flexible product modules, the suite allows you to choose a customized solution that grows with your practice needs and electronic readiness over a period of time.
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