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Empowering Your Health Care

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  1. Empowering Your Health Care Clinton Evans, D.O. Family Medicine September 8, 2012

  2. 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

  3. Delivery of Health Care

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. What Medical Issues are Addressed

  10. 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

  11. 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

  12. 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

  13. 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

  14. Your Personal Health • All health starts with how you treat yourself • Weight management • Daily exercise • Healthy diet

  15. Screening Test • What is a screening test? • What makes a good screening test? • Risks versus Benefits • Specificity • Sensitivity

  16. 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?

  17. 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

  18. Colonoscopy • Starting at….. • Age • Risk Factors • How often? • What to expect • Related screening tests – hemoccult, fecal DNA • Virtual colonoscopy

  19. 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

  20. Breast Cancer • Clinical Breast Exams • Self Breast Exams • Mammograms • Screening • Diagnostic • Ultrasound • Breast MRI Breast Cancer Awareness Think Pink Originated here in Redding!

  21. 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

  22. Prostate • DRE – digital rectal exam • PSA

  23. Cholesterol (Lipids) • Atherosclerotic Vascular Disease • Total cholesterol, HDL, LDL, triglycerides • When to start: based on risk factors • Includes family history, habits like smoking, age

  24. 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

  25. Using Technology • Computer Resources • Smart Phone Apps • Blood Pressure Logs • Blood Sugar Logs • Exercise Apps • Diet logs • Weight and BMI tracking

  26. 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

  27. Smart Phone Apps

  28. Using Reminders • Apple – RE.minders • Android – Life Reminders • Black Berry – Role Call Reminders

  29. 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

  30. 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

  31. 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