Transcript Empowering Your Medical Care

Empowering Your Health Care
Clinton Evans, D.O.
Family Medicine
September 8, 2012
Objectives
*Understand the landscape of health providers and how
health care is delivered
*Understand Acute Care versus Preventative Care
*Better understanding of how to talk to your health care
provider
*Know Common Preventative Care Measures
*Learn some current useful tools to manage your health
care
Delivery of Health Care
Office versus Hospital
 Office
 Acute, non-emergency problems
 Preventative care
 Hospital
 Specialized care for acute illness and complex problems
 Surgery Center
 Same day surgeries, colonoscopy
Health Care Providers
 Who provides your health care?
 MD, DO, NP (FNP), PA, RN, LVN, RD, CDE, MA, CNA
 Primary Care versus Specialty
 Family Doctor, Pediatrician, Internist
 Surgeon, Gastroenterologist, Dermatologist, etc
 Hospitalist – internal medicine or family medicine
 Board Certification
What to expect at the office visit
 Front office staff
 Collect personal information
 Collect payer information – insurance
 Medical questionnaire forms
 Back office staff
 MA, referral coordinators, billers, office manager
 LVN, RN
What to expect at the office visit
 Average wait time: 15-19 minutes *
 Average office visit time: 15-20 minutes *
 Average time until doctor interrupts patient: 18-23
seconds **
 How do these times effect your visit and care?
* American Medical Association
** Beckman and Frankel
Talking to Your Doctor
 Initial presentation
 What/Who to bring with you to an office visit
 Health summary
 What/Who not to bring
 What kind of medical problems do you have if any?
 Advice outside of the office visit
What Medical Issues are Addressed
Acute Problems
 Acute problems
 How long until you go to be seen
 Too early or too late
 The Win-Win Scenario –treating at the moment of care
 Emergency
 The ER has a purpose
The Preventative Care Visit
 How often – increasing frequency as you age *
 Increasing screenings as you age
 Efficiency of information gathering
 The ideal – indefinite time for discussion
 Reality – limited time to meet the needs of all
Preventative Measures
 Age specific – Pediatric through Geriatric
 Immunizations
 Tests and Exams
 Weight
 Vision
 Hearing
 Blood Pressure
 Heart
 Cholesterol
 Diabetes
 Colon
 Breast
 Cervical
 Prostate
 Bone Density
 Skin Cancer
Organizations with Preventative
Recommendations
 National Guideline Clearinghouse
 USPSTF (U.S. Preventive Services Task Force)
 CDC (Center for Disease Control)
 Department of Health and Human Services
 Women: Stay Healthy at 50+
 Men: Stay Healthy at 50+
 American Academy of ___________________
 American Cancer Society
 National Cancer Institute
Your Personal Health
 All health starts with how
you treat yourself
 Weight management
 Daily exercise
 Healthy diet
Screening Test
 What is a screening test?
 What makes a good screening test?
 Risks versus Benefits
 Specificity
 Sensitivity
Why are some tests not used to
screen?
 Answer: insufficient data to support routine use as a
screening tool
 Example: Cancer antigen tests
 PSA, CA-125 – both can increase in benign conditions
 How can they be useful?
Blood Pressure (Hypertension)
 Annual or Biennial
 When to treat
 140/90 (Systolic / Diastolic)
 How to treat
 First line is always lifestyle – weight management, diet,
exercise
 Low salt intake
 Medication
Colonoscopy
 Starting at…..
 Age
 Risk Factors
 How often?
 What to expect
 Related screening tests – hemoccult, fecal DNA
 Virtual colonoscopy
Diabetes
 Universal screening has not shown an impact
 Risk factors do play a role for screening
 Obesity
 Family History
 Other existing health problems
 Primary disease prevention has the greatest impact
Breast Cancer
 Clinical Breast Exams
 Self Breast Exams
 Mammograms
 Screening
 Diagnostic
 Ultrasound
 Breast MRI
Breast Cancer Awareness
Think Pink
Originated here in Redding!
Cervical Cancer
 What causes cervical cancer?
 Most consistent link = HPV (human papilloma virus)
 What is a pap smear (Papanicolaou smear)?
 How often do you need a pap smear?
 When can you stop getting a pap smear?
 What about the clinical exam?
 Prevention also includes HPV vaccination – ages 9-26
Prostate
 DRE – digital rectal exam
 PSA
Cholesterol (Lipids)
 Atherosclerotic Vascular Disease
 Total cholesterol, HDL, LDL, triglycerides
 When to start: based on risk factors
 Includes family history, habits like smoking, age
Skin Cancer
The most common Cancer
 Yearly skin exam?
 Prevention should start as a child
 Protection from the Sun!!!
 Cover up, Sunglasses, Sun Screen
 Incidence of melanoma =
 about 20/100,000 in 2008 for California
UMSkinCheck – smart phone app
Using Technology
 Computer Resources
 Smart Phone Apps
 Blood Pressure Logs
 Blood Sugar Logs
 Exercise Apps
 Diet logs
 Weight and BMI tracking
Using Technology, Continued…
 THE SELF DIAGNOSIS
 THE FAMILY INPUT DIAGNOSIS
 THE “My best friend’s, brother’s, girlfriend’s, dad’s,
cousin’s friend has these same symptoms with this
disease” DIAGNOSIS
 LEADING TO:
THE INTERNET DIAGNOSIS
Yard Stick example
Smart
Phone
Apps
Using Reminders
 Apple – RE.minders
 Android – Life Reminders
 Black Berry – Role Call Reminders
Creating a Health Summary
 Your own document
 Apps – example: PocketEHR (free version), My Medical Info
 Online portals
 My Family Health Portrait - familyhistory.hhs.gov
 Health Vault – by Microsoft
 EHR portals through your doctor’s office
 What to include:
 Past history including current and prior treatments and surgeries
 Family History – immediate family generally most important
 Social History – example: smoking history, alcohol consumption
 Medications
 Allergies
Organizations with Preventative
Recommendations
 National Guideline Clearinghouse
 USPSTF (U.S. Preventive Services Task Force)
 CDC (Center for Disease Control)
 Department of Health and Human Services
 Women: Stay Healthy at 50+
 Men: Stay Healthy at 50+
 American Academy of _________________
 American Cancer Society
 National Cancer Institute
Summary
 Be your own advocate for your health starting with
taking care of yourself
 Ask questions
 Preventative measures – think of it as a guide
 Keep your own record