"Test Me for Everything!"

There was an excellent article in the New York Times today entitled, “Why Doctors Order So Many Tests.”  I encourage everyone to check it out, along with the comments.

Those of you that are my patients know that I try to take a pretty minimalist approach to testing and medications.  I encourage people to make lifestyle changes before taking medications, if appropriate.  I do not encourage so-called “screening” tests unless they are recommended by the USPTF.  For example, I’ve spent plenty of time trying to convince patients that they don’t need a full body CT scan and that certain women don’t need a Pap smear every year.  Some people take my advice, some don’t.  And that’s fine.  All I can do is make recommendations based on my expertise.  After that, it’s up to the patient.  They are the steward of their own health, and I have no problem with that.

One of the toughest things I have to do is convince people that antibiotics are not needed for a self-limited infection.  This is one thing that I do not cave on- no one can force me to write a prescription that I don’t feel is indicated.  However, I can’t stop someone from heading over to the ER or urgent care center.  Nothing frustrates me like telling a patient that they don’t need antibiotics for their bronchitis, and then having them go to the ER a day later and be given a Z-Pack.  This will typically be followed by a phone call from the patient saying, “You wouldn’t give me an antibiotic and I had to go to the ER.  I took the Z-Pack and I was better in a week.”  My response to this- you would have been better in a week anyway, with or without an antibiotic.

Please, I beg of everyone- try to think of antibiotics as a life-saving treatment that is reserved for a serious infection.  Our armamentarium is limited, and over-prescribing of antibiotics has the real potential to put us back in the pre-penicillin days.  That is a scary, scary thought.

iPhone, running

Favorite Apps

I’ve already mentioned previously how in love I am with my iPhone.  I wanted to spotlight some of my favorite apps that people might find helpful.

This is my favorite running app- RunKeeper.  It has some great features.  First of all, it uses the GPS on your phone to track speed, distance, and pace.  With a flick of the screen, it will pull up Google Maps and trace your route.  It keeps a history of your runs, so your progress is tracked.  Turn on the “coaching” feature and the program will give voice prompts for what to do.  You can create your own workout, also.  Even better, you can program a playlist from your iPod so the workout is synced with music.  Once you’re done, you can tweet about your workout or post your results to Facebook (not that I’ve ever done this, but it’s easy to do).

Oh, by the way, if running’s not your thing, you can set it for pretty much whatever activity you want- biking, hiking, skiing, snowboarding, even swimming.  Swimming???  How, exactly, does one swim with a smartphone?  At any rate, if you want to destroy your phone, apparently you can track your progress via GPS while doing it.

Stay tuned for more of my favorite apps!


Study of the Week!

Now, this is my kind of medical study!  These results were published in the Archives of Internal Medicine this week.  It looked at data from the Nurse’s Health Study, an amazing study that has been going on since the mid ’70 and has analyzed data from over 200,000 participants.

The most recent analysis looked at data from over 50,000 women.  It showed an association between higher intake of coffee and lower incidence of depression.  The more coffee, the lower the risk of depression.

So, what can we take from this study?  Mostly, that we need more studies.  While there is an association between the incidence of depression an caffeine consumption, we can’t say yet that caffeine actually can prevent depression.

I will say this, though.  For most people, it’s fine to have a cup or two a day of coffee.  Enjoy!


Backyard Chickens

These are my chickens.  Well, some of them at any rate.  Right now I have 25.  Within the next few weeks I’ll be down to about 14, as I will be sending most of the roosters to freezer camp.

Why do I have chickens?  Well, the eggs are incredible.  Really, if you’ve never tasted a farm-fresh egg, try to find some.  You’ll never go back to supermarket eggs.  The chickens eat all sorts of yard pests, like grubs and ticks.  They are very low maintenance- we give them water and food once a day and clean out the coops every few weeks (takes under an hour). They also provide my kids with hours of amusement:

Alex hasn’t caught a chicken yet, but that doesn’t stop him from trying.  Not that he’d know what to do if he ever actually caught one…

Behind the scenes

This is my paperwork.  It takes up about 2 hours a day, every day.  This is in addition to the 8 hours I am seeing patients.  It consists of lab and x- ray results, prescription refills, consultation notes, and phone messages.  This is what the pile looks like at 8:30 AM.   It gets replenished throughout the day.  Every second that I’m not seeing patients, I’m either dictating notes or tackling the pile.  This is how I spend lunctime, too.  Every piece of paper has to be carefully read and reviewed.  Luckily, I have a fantastic PA (physician assistant- Hi Dorothy!).  If it wasn’t for her, I’d be really in trouble.

So, if it takes me until the end of the day to return a call, this is why.  If you need a form filled out, don’t expect me to do it instantly- drop it off in advance.  If you call the office and refuse to tell my nurse or medical assistant what you need to talk to me about and just say “I will only talk about it with the doctor”…well, you’re going to have to wait to talk to me.  I will call you back, but the pile has to be tamed first.  So patients, please have patience.
iPhone, medicine

My Accessory Brain

“No, Mrs. Smith. I’m not texting on my iPhone during our appointment. I’m just using my accessory brain.”

That’s what I call the various medical references that I carry with me at all times. Most doctors have an accessory brain of some sort. For the most part, I need to use it to look up drug dosages or to do some calculations. However, my accessory brain has come a long way, baby! Here’s my first one, dating back to my time as a third and fourth year medical student:

The book on the left is a house staff handbook, chock full of quick references and mnemonics.  Notice how well-worn it is- I got a lot of use out of it, and actually still occasionally look something up in it.  The one on the right is a Pharmacopoeia- a drug reference.  I also usually carried a Ferri Manual with me- this is a spiral bound book that’s several hundred pages in length, but yet claims to be a “pocket manual”.  I thank Dr. Ferri for my recurrent neck pain and poor posture.

After graduation, I went high tech.  At the time, high tech consisted of very primitive PDAs.  I had one called a Handspring Visor.  It had a whopping 2M of memory and was…large.  It also had this dumb little stylus that you had to use on the touchscreen.  I was always losing that stupid stylus.  However, it had the great advantage of being able to combine several medical references onto one device.

The handspring lasted a year or two, then I took my husband’s Palm Pilot as a hand-me-down.  It was smaller and had more memory.

I then moved up to a PDA called a Sony Clie.  It had this neat swivel screen.  Most impressively, it was in COLOR!  Wow!  I got a lot of use out of my Clie- I’d say it lasted about 4 years, which is an eternity in the world of technology.

The problem is that the pockets of my white coat would still bulge.  I’d carry my Clie, cell phone, pager, and prescription pad all the time.  My posture remained stooped.  Therefore, as technology advanced, I moved with it.  First, I tried a Trio.  This combined my cell phone and PDA into one device.  I still carried a pager.  I hated my Trio.  Hated it.  To be honest, I don’t even remember why I despised it so- I just did.  I probably had it for less than 6 months.  I then moved on to a BlackBerry.  That was better.  I used it for about 2 years.

And then…my love affair began.  It’s a love affair with my iPhone.  We started our relationship in 2009, and we’re still going strong.  All of my medical apps, my running apps, my email, my phone, e-prescribing…all in one cute, tiny package.  I’m not sure if things can get better than this, we’ll see.

In the meantime, I’ll be making future posts about my favorite apps.

And I promise not to text during an office visit.

exercise, Indy, running

Man’s best friend.

Let’s face it. It can be tough to get motivated to exercise.  Really, many of us would prefer to do just about anything other than exercise.  That’s why I suggest getting a workout buddy.  It’s pretty easy to come up with excuses as to why you shouldn’t exercise, but it’s a lot harder to use those lame excuses on a friend.

So, meet Indy.  He’s my workout buddy.  We’ve been running together since 2006.  He doesn’t care what the weather is like.  He always runs at my speed.  He never, ever, passes a chance up for a run.  His only downside?  I have to pick up his poop.  He also gets a bit stinky if we run in the rain, but hey, so do I.

So, if you’re just getting started with a running or walking program and you’re having a bit of trouble getting motivated, find a friend.  How do you do this?  You can check out this forum.  Or you can join a local running group.  If you live in my area, you can join my running group in the spring. Or, you can get a dog (but a friend might be better, since you won’t have to pick up their poop).  Enjoy the companionship and the exercise!