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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

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Empowering your health care

Empowering Your Health Care

Clinton Evans, D.O.

Family Medicine

September 8, 2012


Objectives

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

Delivery of Health Care


Office versus hospital

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

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

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 visit1

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

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

What Medical Issues are Addressed


Acute problems

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

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

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

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

Your Personal Health

  • All health starts with how

    you treat yourself

    • Weight management

    • Daily exercise

    • Healthy diet


Screening test

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

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

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

Colonoscopy

  • Starting at…..

    • Age

    • Risk Factors

  • How often?

  • What to expect

  • Related screening tests – hemoccult, fecal DNA

  • Virtual colonoscopy


Diabetes

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

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

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

Prostate

  • DRE – digital rectal exam

  • PSA


Cholesterol lipids

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

Skin CancerThe 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

Using Technology

  • Computer Resources

  • Smart Phone Apps

    • Blood Pressure Logs

    • Blood Sugar Logs

    • Exercise Apps

    • Diet logs

    • Weight and BMI tracking


Using technology continued

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

Smart Phone Apps


Using reminders

Using Reminders

  • Apple – RE.minders

  • Android – Life Reminders

  • Black Berry – Role Call Reminders


Creating a health summary

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 recommendations1

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

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


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