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Time Is On Our Side (Once Again) | Jan 7, 2015
Dr. Barry
I have just made the biggest change in my medical practice ever. I feel like I am waking from a long slumber where doctors are struggling to work harder and harder for less, and professional morale is at an all time low. A company called Signature MD helped to rouse me from my professional lethargy, and once again I am excited at the prospect of being able to deliver even higher quality health care than I am now. I will have a chance to really practice at the top of my game. Once again I think I will be able to really make a change in people’s lives. I am excited about finally being able to make a difference.
I’m also nervous because this is a fundamental change in my practice. I am adopting a Personalized Care Program in which a limited number of my patients will receive enhanced services, more detailed management of their health and wellness, and a focus on Preventive medicine.
At the core of this new program is time. I’ll have more time to devote to each patient. In effect, I’ll be acting as their Life Coach.
I really don’t have a better term for it yet, but I think Life Coach conveys my intent. Any good healthcare provider, and we have many in Syracuse, can handle your blood pressure, your diabetes and your sore throat. This is midlevel provider stuff, which is important but doesn’t need my skill level. I want to actively follow a smaller number of patients and really provide them more oversight and attention.
Frankly, we all should have this kind of relationship with our doctor, but we will never have it without a program like the kind offered by Signature MD. The healthcare system has been changed into an assembly line with a different healthcare provider for each visit, not enough time allowed for meaningful consultations, and where the standard of care has devolved to some pills, some tests, and then it’s on to the next patient in line.
Walmart says they want a healthcare clinic in every store and want to be the number one provider of medicine in a few years. You don’t have to scour the national news for changes in health care. Look at what has happened to North Medical Center. Clinics aren’t bad…but I don’t want to practice assembly line medicine. Signature MD’s Personalized Care Program will give me the opportunity to spend quality time with patients, including the time to follow the patients when they are hospitalized at any of the local hospitals.
When we doctors turned over your hospital care to Hospitalists (in-house staff healthcare providers), it was a good for the doctors but really not so good for the patients. As a patient, you want the medical professional that knows you best to see you when you are sick, whether that’s in the office or in the hospital. But it’s most important in the hospital when you are most vulnerable to mistakes and miscommunication. Signature MD will give me the time to manage all that and actually be there to assess you in person, and to communicate directly doctor-to-doctor with the physician charged with your care in the hospital.
Yes, there is a fee for all this extra service, but however, because I believe that the health of every single person that enrolls in the program will be improved, I think it will be worth the fee. I think your health is worth it. I think you are worth it. I realize that this program will not appeal to everyone. Some people won’t see the value in a sustained and engaged relationship with their doctor. Some people are young enough, healthy enough and or self-directed enough that they don’t really need the program. Some people simply won’t want to pay an extra fee. I don’t fault them for not taking advantage of this program, but I am hearing from a few people that are faulting me for working on being a traditional doctor again.
By “traditional” I mean having the time to really listen and establish a relationship with each individual patient. I have heard from and respect those who are opposed to this new program. However, I have been given an opportunity to fundamentally change my practice in such a way as to make me feel that I am actually making a difference again. What an opportunity. What a risk. But I just had to take it because the price – better health care for my patients and better job satisfaction for me – was worth it.
This will not be a one-size-fits all, cookie-cutter program. What’s important in healthcare differs from patient to patient. What’s obvious is that this isn’t being addressed in the world of 10-minute office calls. We are just bandaging the problem with these visits and not really focusing on what’s causing the underlying problem in the first place. I cannot get a person to quit smoking or lose weight with a couple of office visits. Complaints of anxiety, depression, insomnia or chronic pain are not treated with a pill and a referral to a specialist. We can do better than this…but we need more time.
The new Signature MD Personalized Care Program gives us the time we need to make a difference. This doesn’t mean that I will be making patients get more tests done. If anything, I could actually end up recommending less testing. Whatever testing that I do recommend will be accompanied by written explanations of all my suggestions as well as comparisons to the national guidelines.
Now, for those people who choose not to sign up for this Personalized Healthcare Program, there are still plenty of options in our office available to you. Starting next year all of my patients that choose not to sign up will be directed to my Nurse Practitioner Zoryana Bozak, who will handle all the routine office calls and physicals. She will be working directly with me and whenever your medical problem needs my direct attention, I will be there for you. If it is a routine visit, if it is a routine visit, you will see Zoryana. If it’s not routine, you still see Zoryana first, or another one of our excellent providers, who then will get me directly involved whenever the situation warrants it. If you feel you need or want to see a physician, we still have Drs. Knudsen and Manfredi taking new patients.
I didn’t get into medicine to see as many office calls as possible. I got into medicine because I enjoyed the intermixing of the sciences and dealing with people’s problems and personalities. I have lifted my head up from the din of visit-after-visit where I don’t know if I am making a difference to say, “Wait a minute. This isn’t how it’s really supposed to be. This way is not really allowing me time to change peoples lives.” There must be a better way. The new Personalized Care Program that I’m offering is the wake-up call to a better way. At last, time will be on our side.
Driving Me Crazy | Dec 15, 2014
Dr. Barry
One of the most delicate parts of my job as a doctor is the conversation about whether the mature patient should still be driving. You know the folks…they brag that they never had a ticket or an accident but can’t walk steadily and reliably across the parking lot.
How can you claim you are “safe?” Look at you…your vision is not great. Your hearing…well the less said about that the better…you can’t turn your neck more than a few degrees due to arthritis…you can’t really feel your feet can you? Your strength, focus, coordination, endurance, etc. are all far from peak and you still say it’s fine for you to get behind the wheel of two thousand pounds of steel and plastic and gasoline. All WE can think about is you hitting some kid or plowing into the school bus and the whole thing being quickly engulfed in flames. And it will be our fault because we should have somehow forced you to stop driving.
The scope of the problem? The CDC says that of 2009 there were over 33 million senior drivers on the roads. Fatal crash rates start to rise at age 75 and rise up sharply after age 80. This doesn’t always mean they have more accidents but they get more injured from the accident. 500 senior drivers nationally are injured every day in America. According to the Insurance Institute for Highway Safety drivers over 75 years of age have higher per mile accident rates than middle aged people but still LESS than younger drivers.
First, this whole sticky wicket of senior driving safety becomes mute once the self-driving cars finally arrive. “Car, take me to church, hairdresser, my kids’ house,” etc. How great will that be?! Just say where you want to go and sit back and read, relax, take a nap, make a phone call without worrying about driving distractions. That’s something I will pay extra for when it’s available. I am not saying everyone has to let the car drive them…the tread heads, as my sister Marijo refers to them, will say it takes the joy out of driving, etc. so let them stay behind the wheel but make them pay extra for it because in the end it will not be as safe as letting the computer do it for them.
Until that happy day we must wrestle with the personal and public issue of who should be driving and for how long. Should women be tested more often than men? When do you start testing…only after an accident? Retest everyone at age 80? Of course someone will say testing is racist or sexist. None the less…if you ask me about your ability to drive a car I am going to give you my stock response and no one likes it! If you wonder about your ability to drive, go see the specialist…go take a driving test. You can use the DMV but you can also call one of the driving schools and they will evaluate your driving. Taking the refresher classroom course absolutely doesn’t count. Under my benevolent Caesar-like leadership the rule will be established that everyone will be tested every five years. You can do the DMV or you can do it privately. This puts to rest the issue of who to test and when. We test everyone…regularly. Commercial drivers will be tested yearly. If you are 95 years old and pass the test the car keys are yours! And of course did you notice my solution also provides jobs in both the private and public sectors! I wonder what will happen to all those couples where the husband is demented but the wife lets him drive because she hasn’t in years and he is indeed a better driver. That makes me mention that all you older ladies that let your husbands drive all the time…it’s likely you will outlive your husband and it’s a mistake to stop driving just because right now things are easier. Keep your skills up!
So you don’t think your mom should drive anymore…you do know that taking away her driving is like stabbing her in the heart with a dagger. Maybe that nice carving knife she got your husband for Christmas…that’s it…the very one, and remember to come up under the ribs. You want to set off indoor fireworks? Just try working in “you should probably give up driving” into casual conversation. The fact is that you are robbing her of her independence. It might be what you think is the right thing to do but it is not likely to be appreciated. This doesn’t usually go over well. It’s a sure trigger for depression…akin really to the loss of a spouse. And I am supposed to make that better with a little white pill?
Sometimes one of my roles as a physician is to be the bad guy…to take the blame. Much better to be mad at me regarding getting some help in the home or mad at me for telling you not to drive…rather be mad at your family member. I routinely refer patients for driving testing but they never go…I am pretty sure they are afraid of taking the test and not passing. I can’t force them to stop driving. I can’t force them to take the test. I can only offer my advice and insight. What I cannot do is notify the DMV if I think you are unsafe behind the wheel. It is a violation of your confidentiality. So you are safe in bringing up your driving concerns but I am always going to be on the side of personal freedom. Now, while I can’t report you to the DMV your family or for that matter anyone who wants to can. Although the NY DMV says on their website that a physician can report a patient my lawyers tell me this isn’t true. There is a form you can fill out that will prompt an evaluation of the person’s driving skills.
Although my periodic retesting scheme makes sense to me as long as the current system allows seniors the right to drive I don’t think we should infringe on this right unless and until something happens…the fender bender in the mall…the garage door frame…and yes, even some of the worst sort of accidents…your freedom and independence are important enough for this risk. In the end, it comes down to common sense like not driving at night…not driving long distances to new places…extra care when backing up…keeping your cell phone available but not in use, etc.
So let’s keep giving our seniors the benefit of the doubt when it comes to staying independent when driving. When trouble finally happens, an independent reevaluation of driving skills takes the emotion and guilt out of the decision.
Don’t forget the fair. You owe it to yourself and the grandkids to go. Stop with the negatives and enjoying the sun, the sites, the wild food, the music, the exhibits, the petting zoo, the Iroquois Indian Village…how can you have this great attraction in your backyard and not support it and enjoy it!
It’s Time to Stop Wining | Dec 15, 2014
Dr. Barry
It’s the December issue and I usually spend it exhorting you to spend a little extra time on the friend and family part of your health equation. To get out and do stuff…whether it’s Lights on the Lake…going out to just one of the seasonal shows at the Palace Theater…going Cross Country Skiing at Highland Forest…we have covered this ground and you should be picking up your phone to make arrangements. You’re going to say…let me at least read through the rest of the article and then I will make the calls. Here’s the problem…I know you…you have good intentions but at the end of the article you are just going to forget about it. So, it’s much more important to stop now and at least make one new plan than to read through this article…you can always come back to the article…you probably won’t make a new plan unless you start right now.
Well, we are all deeply flawed individuals as my colleague, Dr. Manfredi, likes to remind me. So let’s get on with the article. Did you think I misspelled whining at the top of the article? No, I really do mean it’s time to stop wining. For more than 5 years our office has been quietly giving out a bottle of wine to our patients who had appointments around Xmas time. We appreciate our patients and thought it was a nice touch…giving a gift of health. It’s well known in the medical community that a modest amount of wine is good for your health…of course there are the exceptions and therein lays the problem. With exceptions come problems. With problems come headaches. Headache cause us to say it’s time to stop the gifting, at least for now.
Let me elaborate…we want to do something nice for the holidays but not if it’s going to make people mad at you, give you new legal issues and potential liabilities, take up too much time and money. Frankly the money part of the equation was not the main reason we are stopping the giving of the wine. We had people complaining that they did not like our choice of wine. We had people complaining that they were good patients but did not come by around Xmas but surely they deserved a bottle. We don’t want to give a bottle to a person with a history of alcohol trouble but what if the person says “I have been proudly sober for 10 years but I see other people leaving with wine and I wouldn’t mind bringing the bottle over to my sister’s house for the holidays.” People would come in for a problem…have a recheck for the problem three days later and want another bottle of wine! Frankly when we had so many people expecting a bottle like we were some assembly line it isn’t a nice healthy surprise anymore. It’s lost the magic. It’s lost the meaning of the gesture. So, no more wine from Preventive Medicine Associates. Please don’t take it personally.
Instead of giving individual gifts of wine, we will spend the money on several local projects including supporting the Maria Desantis Xmas show at the Palace Theater. It’s a great show for the young and old alike. The reason for the season is all about the Birth of Jesus…but anyone of any religion can understand this is a time of year to enjoy with friends and family. You should absolutely watch some version of Scrooge each year. If you can’t take something important away from this story you are beyond help…and I know you and there is still some hope for you. Well, I for one have not given up on you.
Another way we at Preventive Medicine Associates will show our gratitude to our patients is in support of some local family that needs help during the season. We have done this for years already but this year we can bump it up a few notches. We will put some smiles on some family faces this year.
So please understand that we thought that the wine gifting idea had run its course. I wanted to give out little jars of horseradish because along with garlic and ginger it is one pf the best things you can put in your mouth but there was surprisingly little support for the idea around the planning table. So we are doing more for the community in general by sponsoring the Desantis show and by being Secret Santa to some families. Hopefully you will understand and agree with our decisions and motivations. Wishing you a healthy and happy Christmas.
Now is the time to make those family Christmas plans and don’t forget Maria Desantis at the Palace Theater Sunday Dec 14th. Next month…why and how I hope to fundamentally change my practice of medicine. Stay tuned.
Ride On! | Nov 10, 2014
Do you mow your lawn? I cringe when I drive around and see people mowing their lawns and weed whacking without hearing protection. Don’t they know what they are doing to their hearing? How can they get used to that clamor? I am all for full employment for their audiology (hearing aid) colleagues but I would rather get my hearing aids at age 80 than age 60. Hopefully they will be cheaper, better, and/or covered by insurance by then so as so many baby boomers will be deaf that they will insist on coverage. Riding the lawn mower has saved my life. Well, maybe not saved my life, but certainly has changed my life. I dare say that only the beatudinous (WHAT????) vision that is my wife has had a more positive influence in my life than sitting on my lawn mower.
When we moved to Lafayette in 1999 I bought a new riding mower and I have a fairly big yard and it can take me just under 2 hours once or twice a week, depending on the temperature and the rain, to get the job done but at that time is spent more inside my mind than on top of that tractor. So, it’s not the actual task of mowing the grass that has helped me so much as the time spent listening to lectures on my MP3 player. I have listened to lectures from the Teaching Company about Ancient Greece and Rome, about the history of medicine and about music appreciation, etc. the lecturer makes or breaks the course and there is none better than Professor J Rufus Fears but he limits himself to historic stuff. Too bad because he could read the phonebook and make it interesting. The history of medicine lecturer was okay but of course the subject matter was important to me so that was pleasant listening. The lectures on music appreciation and sentence writing are so much denser and the speakers seem to drone on and I haven’t gotten through those series yet. Right now I am working on less history and more introspective stuff from the Mind Valley Academy. Stuff about meditation, quantum jumping, positive visualization and and positive vibrations.
Sure I will just listen to music from time to time but I can listen to music anytime and with the lawn mower I know I have a solid block of time to try to mentally absorb something. It’s like reserving a block of time to devote to a book you’re reading…I don’t want to read it in 10 minutes dribs and drabs. I want to have time to really get a few pages into the story…get up in there…immerse myself in the story…and you can’t just dp that in a few minutes here and there. Same thing with the audio lectures…I want to listen to the whole block…not just five minutes at a time.
So I think I have learned something about the world around me and hopefully about the world inside my head and who amongst you can say they are doing that on a regular basis. Hold a second…you can…anyone can. MP3 players like iPods are pretty cheap and if you can’t figure out how to get files on someone in your family surely can or you can YouTube it!
Having your mind engaged while your body is doing some repetitive task can only make the time go by faster and perhaps you will feel better at the end. Surely there is some subject you have an interest in…besides fantasy football and fishing…expand your mental horizons, not your waistline.
So far no one has asked the question about what I am doing the rest of the year when the grass is not growing. Well, I am listening to less lectures I can tell you that. On the other hand it gives me a chance to relax and enjoy when I am skiing or snowmobiling. You can’t have your mind on “go” all the time but you should try to get it in go some of the time.
Continuous Quality Improvement as they call it in the Industry. Taking Care of Business as Elvis Presely used to say.
My colleagues at the University Hospital have a slogan that says “Knowing changes everything.” With all due respect, that’s not true at all! Everyone knows you should quit smoking. Everyone knows you should get more diet and exercise. Knowing doesn’t change everything. Action changes everything. “Change gonna come” said the great Sam Cooke. Are you going to bring change to your life? You know it starts and ends with you. Maybe you will give thanks this season for your good health and spend a little energy making sure you stay healthy. Change a little something…in your diet, in your habits, in your thought process and see how you feel.
Say What? | November 10, 2014
Please check back soon.
It’s All in Your Mind | July 9, 2014
Dr. Barry
Sure I read the big journals to keep up…JAMA, New England Journal of Medicine, Table Hopping, etc…I want to be reasonably up to date with the “scientific” literature but I also try to keep an open mind (albeit attached to a somewhat skeptical eye) about the out of box subjects like energy fields, coherent rhythms, intuitive information systems, field versus particle psychics…as Einstein is said to have put it the particle is wholly responsive to the field. Are we really “particles” dependent on the energy fields around us? What about the energy fields each of our bodies generate. Can you have an effect on these fields…does it make a difference to your health?
There is a lot of talk…scientific and otherwise on this subject right now. University level talk. This isn’t about psychic fairs and palm readings anymore. This is using the concept of physics and metamorphosis to try and explain the universe around us we can’t see but know exists. I have been reading a lot about this recently…from a variety of sources. Maybe it’s just because I want to believe that with the power of your mind you can change things. Maybe you can’t bend a spoon but can you break a habit? I have always said attitude is everything…will it turn out the Power of Positive Thinking can affect your health? Well, I sure believe the opposite. That you can will yourself into poor health. That you can let stress really affect your health. That depressed people are generally sicker people than those who aren’t depressed. There are a lot of people who think that you can affect your health positively with just your mind. Either these people are the paradigm shift ahead of the rest of us or they are kooks…however well intentioned…but kooks nonetheless. I am hoping for and betting on the paradigm shift but that doesn’t mean I won’t “hedge my bets” by looking for the real science behind this stuff as it becomes available. There are people out there who think they can affect your energy fields with their energy fields as well…giving you a psychic energy manipulation to fix your fields. In this area we have some “real” science to guide us…referring to the practice of reiki now…there have been two reviews published in the International Journal of Clinical Practice and the Journal of Alternative and Complementary Medicine that conclude that reiki “is not an effective treatment to any illness.” Astonishing as it may seem a nine-year-old student named Emily Rosi published in the Journal of the American Medical Association study where she showed that “Therapeutic Touch”, which is reiki by another name, could not be shown to exist. The practitioners specifically trained to feel and manipulate energy fields could not do so when under controlled circumstances. Don’t get me wrong…I know the body puts out electrical fields…what I don’t know is whether you can externally manipulate these fields – especially not with the power of your mind. But I certainly do feel you can manipulate your own energy fields! I do think the power of your mind cannot be underestimated. Obviously a lot of coaches, trainers, etc. would agree with me.
I found out about Quantum Jumping when I responded to an email from Mind Valley Academy. There were many courses on self-growth, personal improvement physically, mentally and spiritually. Obviously I haven’t taken all the courses but I am in the midst of several series including the one on Quantum Jumping…Burt Goldman formulated the technique he labeled Quantum Jumping using a meditative and visualization technique to “jump” within your mind to an alternative universe where you meet a better you…you know the better you if I just went to the gym more, I just kept my weight down more, if I only reached out to my friends more…THAT better you…in your mind you now hang out in that alternative universe with your best self….you spend some time with him or her…if follow what they do…how they act…it’s you after all so the stuff they are doing is what you could be doing yourself…now jump back to this world and try to follow the same techniques and habits here. Bring the habits and patterns of your perfect self into this world. This is obviously only my poor paraphrasing of only one aspect of his technique but it could be really positive stuff if you let it and are open to it. Aren’t all the great athletes supposed to use visualization techniques to improve performance? Absolutely no reason you can’t either. And the great thing is that all it takes is your mind. No expensive equipment. No special uniform. No special time or schedule you have to keep. No need for a partner or group.
It’s about Mindfulness…living your life examined not going through the motions. I know the term Mindfulness is a little “soft”…a little psychobabble sounding but regardless of the baggage I do think it refers to a life examined….living 50 years not one year 50 times. I like that concept and it’s no better represented than in the movie Groundhog Day…this poor guy lives the same day over and over until he “gets it right” and can move forward. It’s one of my favorite movies because it’s both funny and thought provoking (at least to me) without being preachy.
In the same vein I also enjoyed the movie About Time. It’s about a guy with the ability to go back in time and fix mistakes. He doesn’t kiss the girl at midnight on New Year’s Eve the first time around so, if he wants to he can go back and relive it and kiss her this time. His father from whom he inherited the ability tells him his personal little secret is to relive each and every day. Didn’t make the right move on the date? Didn’t stand up to the bully? Mindfully he would monitor what he did/what he said/how he acted each day so he could improve it on the “repeat” day. In a great twist the son improves on his father’s technique by living so alertly and mindfully that when he encounters whatever situation he would want to possible do-over, he was alert and mindful enough to do it “right” the first time.
You want to feel better? Try going on YouTube and watching one of the over 100,000 motivational videos…they are usually pretty short and super positive. Best to do this early in the day so you can use the positive energy that same day. Better than any pill from a bottle.
Let me finish with a little humor. Adam is in the Garden of Eden but he is a little lonely. He petitions the Lord for a mate…the Lord tells him he can make a perfect mate in every way…a great partner in bed, in life, perfect match in every way…Adam says, “Sounds great! What will this cost me?” The Lord responds, “The perfect mate will cost you an arm and a leg.” Adam then responds, “Well, what can I get for a rib?!”
What Change May Come | Jan 7, 2014
Dr. Barry
Obamacare…surely you know I have thoughts on this. It directly impacts my business in both ways…getting insurance for my employees and figuring out how it affects my patients. There is much I know. There is much I do not know. I do know it’s a mess. A big mess and it’s going to get messier from the sounds of it.
Okay, let’s start with the obvious. Before I go criticizing the President and his plan what’s my alternative? I used to think the problem was too big to solve…that unless I devoted hours and hours to the plan I would never get it right or understand the nuances. I thought I would have to spend countless hours listening to the economists and the “thought leaders.” Luckily, as it turns out, it came to me out of the clear blue…of course I think that’s really the fulfillment of the subconscious ramblings and ruminations of my mind until it surfaces in my conscious but call it clear blue if you will. I’ll take it from wherever it may come.
So, my plan is simple…just extend Medicare or Medicade to whomever wants to buy it…don’t make it mandatory. If you have low income you can buy into Medicade. If you have more money, have a job etc., you can buy into Medicare. You have to pay something. You can’t get coverage for free. I don’t have the exact number but roughly 20 cents of every dollar you pay to Blue Cross Blue Shield goes to the paperwork and the processing and the advertising, etc. All those $200,000+ salaries which seem quite nice for a not for profit organization have to come from somewhere (I’m only bitching because I don’t have one of those aforementioned jobs!). Medicare on the other hand charges more like 5 cents per dollar. That’s a huge difference when you are talking about the number of dollars in the system. You don’t need a new tax code or more IRS agents. You don’t need a super expensive website that still doesn’t work more than a month after it’s supposed to be working. You need only expand systems that are already working but need significant reform…not replacement or reinvention.
Libertarians should love my plan because it preserves choice. Republicans should love my plan because it doesn’t set up a new huge government bureaucracy. Democrats should love it because it offers an option for everyone to get insurance. Insurance companies would love it because it still leaves them in the game because part of Medicare…most of Medicare for that matter…involves people choosing between Medicare plans that that are supplemented by the private insurance companies, like Excellus, Atena, AARP, etc. So it’s winner winner chicken dinner but that ship has probably sailed already.
So, even though we don’t really know all the details on Obamacare, we do know a few things:
1. The plan is supposed to provide insurance to everyone
2. The plan is dependent on getting young, healthy people to sign up in order to cover the cost of older people
3. There is no penalty or surcharge for “pre-existing” conditions
4. Part of the plan calls for doctors and hospitals to form groups to “manage patients.” Translation = manage costs
It’s this manage patients part that interests me and should interest you. It’s basically the return of a previously tried and abandoned form of reimbursement called captivation…this was a plan put forth by insurance companies years ago that gives the doctor and/or hospital a set amount of money to care for a set amount of patients. So let’s say that I am given $100,000 to take care of a set of patients for a year…if, because I have a lot of young people who don’t need much doctoring, there is money left at the end of the year I would get some of that as a reward for giving frugal care. If, because I have more patients go to the hospital, or have more difficult to treat diabetics or do more tests, and there is no money left at the end of the year I would be penalized. The name of my practice is PREVENTIVE medicine associates…so I do think it makes sense to order lots of mammograms and colonoscopies and check your labs frequently when you are on blood pressure meds or hypertension meds or diabetic meds. I would rather be safe than sorry.
Also, the part where preexisting illness isn’t penalized is crazy! You don’t pay the same for insurance for a Ford as a Ferrari. Why should a diabetic smoker pay the same rate as a healthy person? Now things like Multiple Sclerosis…that you don’t have much control over contracting would be treated differently. Actions have consequences…so do inactions and I would have an appropriate sliding scale. So Obamacare is going to give medical access to the chronically ill who couldn’t previously afford it…how is this going to cut costs?
Sure, there is lots wrong with the current system. Prices are crazy. More of these expensive tests keep suggesting other even more expensive tests without even giving you a firm diagnosis. Deductibles are out of sight. Non-generic meds cost an arm and a leg. There can be long waits to see the specialist and communication between doctors is still last century. I don’t see how Obamacare can fix these issues. They say they want to focus on primary care and encourage more doctors to go into primary care but for the last decade we have faced a potential 30% cut in Medicare pay each January 1st unless the President signs each year a bill overruling this law. Hard to recruit people to go into a profession that has faced this potential 30% cut in pay annually for the last decade or so. A big distinctive to go into primary care is that specialists make twice the income the primary care doctors make…would even a 10% increase make a difference? Don’t you see a lot of young doctors going into primary care? Not in Upstate New York you don’t.
My profession is under siege. Between lower reimbursements and much more paperwork and pre-authorizations and rising expenses and dealing with the electronic medical records and the daily dreaded risk of malpractice…morale has never been lower. Doctors have been de-selected by insurance companies without warning or obvious cause and with no real recourse. Luckily I am an optimist (of the Lafayette branch) so I have promised myself to always look on the bright side. Just because most can’t see a bright side doesn’t mean there isn’t one. This will be a challenging next few years for doctors and patients alike. Don’t have a thrombo over things you can’t affect. Try and find the humor.
In the meantime, don’t rely on insurance companies or the government or your momma or supplements…take care of yourselves with the old tried and true…diet and exercise. Exercise and diet. Excelsior!
Join a Club! | September 12, 2013
Dr. Barry
A few months ago I urged you to take a hike…my advice this month is to join a club. This article is not for you folks with small kids. You are plenty busy with homework, housework, the soccer league, bunko night, etc. Your world is probably busy and varied. You focus on the kid and that’s god and important…but at the risk of your current scorn (you know who you are) I again urge the ladies to not forget about the big baby. Oh I can almost see you sneer as I write this. There goes mister misogynist, mister sexist, mister me me me. Compare and contrast that sneer against your expression as you sign the divorce papers. Is that too harsh?
Plan some time with your spouse that doesn’t involve the kinder if you value that relationship. It was just the two of you in the beginning; hopefully it will still be the two of you together when and increasingly if the kids move out. That doesn’t happen on autopilot. Maybe it did for your parents’ generation but not anymore. This is the family we are talking about, your family…isn’t a little investment in energy and time appropriate? I’m talking about date night. You can go with other couples or a group or other people just not with the kids. You know it’s different when the kids are around. So, you young professionals with kids YPWK’s (follow them on Twitter…hashtag WTF). You people should skip the rest of this column and maybe read the exercise ladies column or the guy who writes about the corruption of our government both locally and nationally. There’s nothing more for you to read here…move along. Thank you very much.
Now, I guess I am writing this column for you widows and retirees. Most of you have one thing in common. Your world is shrinking people! You are hurtling up! Are you making new friends or losing friends? People keel over…interests change…all kinds of shenanigans…but most of us I think could use a bigger support group. It’s really very easy to get socially isolated. It’s also very easy to fix….Join a club. Wine tasting…club for that. Giving toasts? Club for that. Book club? Plenty of those. Poker club? Sure thing. Royal Order of Whateverthehell. The Ladies That Knit on Their Knees. Shriners. Optimists. Odd fellows. Church groups. Sewing groups. Canning clubs. They all share the commonalty of getting you out of the house for new experiences, and a chance to meet new people and to do new things, and to possibly make a difference in the world. The retired population has such a huge amount of collective experience and wisdom and it’s going to waste when you just sit at home watching NCIS for the 50th time. Social isolation is a real problem with real medical implications. I’m not going to quote any medical journal here because I don’t have to. Real life examples abound. Look at your Momma (not my momma, mind you!). Or your mother in law. Are they doing the same things now they did 10 years ago? Is their social circle getting bigger or smaller? I think most people don’t stop to realize just how limited their activities have become…most of us are up for a challenge, ie. invited to dinner or a movie but most of us are not great at challenging ourselves ie. spontaneously deciding to take a class or join a club.
As I write this I got the Cazenovia College extended learning catalog in the mail. OCC I’m sure has equally diverse offerings. You can take all sorts of classes…Hypertufa Garden Sculpture for you artists…Understanding the Mind of a Dog for you animal lovers…Photography, Soup Making, Whittling, Jewelry Making…quite the smorgasbord of offerings. Why, you could probably teach a class but I am happy to get you back in the classroom on the either side of that little desk. Most of these classes are one to three sessions long so we are not talking about a major commitment here. But we are talking about a commitment to yourself. Frankly, I’m not sure you are up for it. I mean look at you…when was the last time you really and truly tried something different. You don’t even try different restaurants anymore…you go to the same place and order the same thing all the time. It’s not sad but it’s not joyful either. You don’t have to turtle up…you don’t have to close window after window in the house that is your life. The view can’t be all that good once you close that last window…perhaps its similar to the view from inside the casket! You don’t have to rehearse for it…the hearse will come in on its own good time.
“I don’t fly anymore.” “I won’t drive downtown.” “I have stopped visiting the family that lives out of the area.” All these statements tell me you have a problem. Sometimes it’s a medical issue…many times it’s not. I view that as an integral part in my role as Doctor/Life Coach. It’s not all about sore throats and rectal exams…maybe I can help you with the social issues as well. It doesn’t cost extra and I have had a lot of people that are going through the same thing you are. I see what the successful ones do and I see what the failures don’t do…any chance you want to really explore the issue? Or, just continue to live in a smaller and smaller universe. You can expand that universe immensely with a club, group, organization, etc. You will find people who are different from you and people who are not. You will really enjoy some people’s company and will grow to dislike that one or two people in any group that tweaks you.
It’s good for you physically, it’s good for you mentally, I think it can be good for you spiritually, tell me again what’s stopping you? Yes I know about inertia. I don’t live in inertia, I live in Lafayette…I am a member of the Optimist Club there so you know I’m walking the walk…repeat after me: “Every day I wake up and I can improve something in some way…maybe improve myself in some way, maybe improve my surroundings…any little thing but going forward in some way, or I can get older, weaker, poorer of spirit, etc.” It’s a choice you make every morning you get up. Choose to get involved! Join a club!
Try Something New…Yes, Yoga! | May 9, 2013
Dr. Barry
This article will hopefully be short…short, sweet and to the point. How’s that for a change? I know how well you listen when I lecture about diet and exercise…so if you don’t follow my simple recommendations about the basics of your health, how likely are you to try something new? Well, hope springs eternal so I thought I would write about something that I know can benefit anyone. Yoga. That’s right…yoga.
You should do yoga. Not try yoga…do yoga. You should do it if you are injured or sick. You should do it if you are well. You really have no good excuse…oh you have plenty of excuses but each and every one can be overcome if you really want to. Instead, when I mention yoga you draw back like I was swinging a rattlesnake in your direction. I really can’t understand why you are reluctant. Yoga can be done very cheaply. No special uniform is necessary. You can practice it at all skill levels in the same setting. Young or old. Male or female. You don’t need a partner. You can do it alone to a tape or take a weekend retreat. You know my mantra…diet and exercise…exercise and diet. But if I were to amend my mantra it would be diet, exercise and yoga.
I often get a funny look when I recommend yoga. People are willing to risk getting hooked on pain pills or having ulcers with the nonsteroidal drugs rather than consider yoga. People seem willing to have surgery or have needles stuck in their backs, risk infections or go for rounds of and rounds of physical therapy but are not willing to try some prolonged gentle stretching program. I’m not saying you shouldn’t do physical therapy…I’m saying you should do both. It’s a good fit with both cardio programs and strength building programs. So what’s stopping you. There are yoga classes all over the place…the fitness center…the church recreational center…the firebarn…but you can look for a dedicated studio if you want to class it up a little. I take my classes at a dojo in Liverpool. If you are reluctant to do yoga with others or are somehow worried about embarrassing yourself in front of others you can get a DVD from the store, the Internet, the library, and try it at home. Taking a class with others works better for me for some reason but I do tend to keep my eyes closed most of the time or maybe it’s that I’m so focused on me I don’t notice much else. Please hold the cracks about me focusing on me all the time, anyways.
So yes, I recommend yoga. This isn’t about religion. This isn’t Jesus versus the Buddha…this is a set of exercises that stretch and realign your spine and body and seek at the same time to relax you and get you in touch with the basics…like breathing and physical self-awareness. By that I mean listening to what your body is trying to tell you. What hurts and why and how you can possibly make it better with stretching and better balance and posture. How is that not a good thing? What keeps you from trying? No, you may not break a sweat during yoga…you might but it’s not guaranteed. You put as much into it as you like and of course I think the results reflect how much you put into it. Yoga tests not specifically a cardiovascular exercise…it’s not aerobic and it is not weight training but that doesn’t mean it shouldn’t be in your exercise program. If you really have an exercise PROGRAM hopefully that doesn’t mean just doing the same exercise every day. Of course consistency is important but more in terms of frequency…there should be some variety in your exercise and yoga should be just one part of your pattern…
Of course there are multiple types of yoga but I’m referring to the slow set of repetitive stretches that challenge your range of motion and balance. Opens up your spine and lifts your spirit. Sure it’s uncomfortable at times but that’s what the slow stretch is all about…you get all up in that discomfort…you own that discomfort…you map that territory…you’re not paying taxes on that discomfort but it’s just a matter of time…that’s your personal discomfort…then…as you learn to let go of the tension…the position becomes comfortable and you decide if you want to challenge yourself further.
I have never left a yoga class not feeling relaxed and somehow more centered and peaceful. I know that sounds a little “soft” but you can’t understand the feeling if you haven’t done the class.
I’m not the only one recommending yoga. The PX90 program has a yoga component. All the high-end spas and workout places have yoga available. I have never left a yoga class not feeling relaxed and somehow more centered and peaceful. I know that sounds a little “soft” but you can’t understand the feeling if you haven’t done the class. How long that peaceful sense lasts depends mostly on me…sometimes it’s hours afterwards before my innate pessimism returns…sometimes it’s minutes…why oh why are you pulling out coupons in the seven items lane at my beloved Weggies. I overlook your having 20 items in the 7 items lane because I’m feeling good after yoga but when you pull out the coupons suddenly the old Joey is back. Still, my point is that yoga makes me feel better both physically and mentally and I know it will help you too if you would only give it a try. It’s May 2013 and it’s just the right time of year that you tried something new…or you could keep coming to my office for the drugs that give partial relief, see the chiropractor, go through physical therapy again, another round of MRIs, injections or surgeries. If that’s working for you, great. But I see many people who are not getting better or feeling well despite the above. Yoga is an essential tool you should have in your personal health tool box. The instructor where I take my class usually ends with an expression that goes something like “thank you for taking this opportunity to quiet our chattering monkey minds.” You know how that resonates with my prior writings about how the day to day grind dulls us and obscures what’s important…we focus on the minutiae and forget about the big picture. Yoga will help you stretch thoroughly and relax for at least a time. It’s up to you to and me to make that time last longer. It’s up to you to make the time to give yoga a try. Until then…get well…stay well.
Get Your Healthy App On | April 8, 2013
Dr. Barry
I write this month about apps for the smartphone. If you don’t own one now the experts say you will soon, the next time you upgrade your phone for instance. In roughly two years’ time therefore, the only person on the planet without a smartphone will be me. Now I had a smartphone but gave it to my daughter and got a militarized flip phone so I can get it wet and not hurt it. I didn’t use the barcode reader and the night sky reader or the Angry Birds game whatever that is. I didn’t need all the fancy bells and whistles. I couldn’t read my email without glasses so it’s back to the primitive phone that only makes and receives phone calls. Can you imagine my primitive state? Smart phones do so much these days, from GPS to capturing photos of what you ate last night. How did I ever get by not getting a photo of your sushi plate emailed to me while I’m trying to read. The ugly downside to the smartphone is so obvious to everyone over 20. They intrude on real life. How many times do you see someone at the dinner table checking their email while a conversation with real live people occurs around them? I was in the Caribbean recently with my wife and I marveled at the obviously American family sitting next to me in the outdoor dining spot…the gentle warm breeze…the sights, the sounds and smells. The family of four was all sitting there each one immersed in their own device. It looked like two iPads and two iPhones from the dim glow but really…you travel thousands of miles to “get away” and still can’t bear to really separate yourselves from your tech? don’t you know how ridiculous it looks for you to be frantically thumbing these little pads constantly?! Listening for the furtive tweet honk or other personalized sound that notifies you that someone or something has something for you? Just as you laugh at me for being a tech dinosaur, future generations will laugh at you for this frantic fingering. How panicked you get when you can’t get a signal and check your Facebook constantly. You look like a heroin addict who can’t get his fix. Heaven forbid you have to endure a little silence or perhaps get involved in the conversation.
There is no way to turn back the techno clock nor would I want to. We live in a world of constant change and miniaturization and I foresee that we will all be wearing glasses in the future that projects a data street or multiple streams based on what we are looking at or doing. Don’t have to look down at your watch or hold anything at all to make a phone call. For that matter the data streams will project onto your contact lenses. We probably already have the little watches that can work as a phone as well. We will do more with our voices and less with the keyboard; at least not a physical keyboard. No, peripheral brains are here to stay and as we seem to be getting dumber all the time it’s a good thing. Don’t think we are getting any dumber? Look to Washington…any sign of intelligent life there?
So let me help you put something in that peripheral brain that can make a difference with your health. And by doing so make a difference in your life. Maybe some free app from the internet can motivate and educate you in some way that has escaped us during your office call. How many of those little icons on your phones are links to something actually useful?
Of course these apps will only work if you actually use them. You must put them front and center in your phone like a photo of your fat self front and center on the fridge. Get in the habit of using them daily…anything less won’t work. There are literally thousands of apps available, some free, some not, and I’m not saying the list below is best but it’s a start. These are from the list I give my patients and I will add it to any apps that people suggest (after I’ve checked them out of course).
So the big areas that a little peripheral brain can help you include quitting smoking, diet and exercise as well as hypertension and diabetes management. You can take great care of yourself without these apps but if they are available why wouldn’t you at least give them a try. One of the hallmarks of people that are improving themselves, one of the reoccurring suggestions from the gurus of self-improvement, one of the recommendations from all the experts in the health industry is to track the data. Using these little phones you can follow your blood pressure, your blood sugar, your exercise frequency, etc. the more you know the better decisions you can make. The very act of keeping track and reflecting on the activity can reinforce good behavior, patterns and lifestyles. More of my patients are keeping their copies of their medical records on their phone but I still don’t know the best app for this.
Most importantly is quitting smoking and there are multiple free apps, but the one with the most umph is My Quit Coach (available at the Apple Store or Droid download sites as are all others). This one has a livestrong association which I don’t know how I feel about but the app is good and the issue of quitting smoking so important. You can chose to quit it at once or slowly and the app tracks differently.
For diabetics I recommend WellDoc or Glucose buddy. Both not only track data but interact with you to attempt to change behavior, results.
To remind you to take your meds, try RemindMe. Most experts think the average patient screws up their meds all the time and the more the meds the more the screw ups. What’s wrong with having that little device that’s next to you remind you to take a pill? Might just be the thing to keep your college age daughter on her birth control pills, or grandma might need help remembering the third batch of pills each day which your old hand me down phone could help her with.
When was your last tetanus shot? No questions about what shot or when with the VaxTrak app. Do you know how many pages of old records I have to comb through to try to figure out when your last pneumonia shot was? Keep track of your own vaccine info.
If you want to stay healthy you have to take care of your blood pressure. If it’s high you have to treat it. If you treat it you should track it and besides knowing more about your own health it proves to your doctor that you are an involved participant in your care. The app for you is IBP blood pressure.
Although I have more to say on this in a future column, if you have trouble sleeping try Pzizz, it’s $10 at press time but worth a try.
For those working on diet…and you should all be, I offer you four choices: LoseIt, MyNetDiary, Mindful Eating and Mindful Bite. I like the first two apps more than the second two, but it’s a style thing, not a content thing.
For those working on fitness and that’s you: MyFitnessPal, C25k, iFit and Daily Cardio Workout. Many also have calorie counters and diet information. C25k stands for couch to 5k, meaning they will go from being a couch potato to fit enough to run a 5k. Pretty neat.
Finally for relaxation…for those of you too stubborn to follow my advice and try yoga, try Breath2Relax or Buddhify. I really like the latter program as you can customize it for commute, exercise, etc.
Lastly for brain training, consider Luminosity Brain Trainer or Memory Trainer Pro. The former is a more thorough program and the latter is something you do while you are waiting for your lunch to arrive. I don’t know if either program will help you remember your girlfriend’s favorite song. These apps can’t help your marriage or help you figure out what’s really wrong with that kid or grandkid of yours, at least not yet. Give them time. I’m working on an article about an exciting new Internet-based treatment program for insomnia. No gimmicks, no fancy machines, no medications of any kind. Nothing to lose or break or have to send back. You can get to the bottom of the problem or you can just cover it up. This new program offers a real, long-term solution that does not require input from you or some kind of work on your part. And of course that means 90% of you can’t be bothered and will ask for a sleeping pill. I know, believe me, how important a good night’s sleep is but I can’t believe taking some medication that powerfully affects your brain night after night is good for you either. What do you know…neither do the experts as recent news stories detail. “Use less, use lower doses” was the recent update from the FDA. Of course, they also recommend not using drugs for more than two weeks at a time, but try to tell that to someone asking to stay on this medicine for all time.
But there is hope, speaking of hope…if you were trapped in the calendar, how would you survive? Yes, this is a mental challenge. Until next month…get well, stay well!