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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

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
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

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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