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A Quick Guide to Finding Good, Healthy Recipes Online
Tweet Share on Facebook March 11, 2011 Comment (1)It’s National Nutrition Month, and the American Dietetic Association is encouraging people to consult dieticians and other health professionals about making good food choices. Friends often assume that as a family doctor, I must know a lot about nutrition. And it's true that during my training, I spent countless hours memorizing the complex chemistry that allows the human body to turn sugar into energy; calculating the content of intravenous solutions for dehydrated children; and giving patients who had lost the ability to swallow liquid nutrition via feeding tubes. But this esoteric knowledge doesn't make me an expert on designing healthy meals for families. In fact, a survey published last year in the journal Academic Medicine reported that on average, U.S. medical schools provide fewer than 20 hours of nutrition education, even less than when I graduated in 2001.
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Food-Borne Illnesses Still a Threat, Despite New Food-Safety Law
Tweet Share on Facebook February 23, 2011 Comment (1)Ten years ago, while training to be a family doctor, I spent several months admitting sick children to a hospital's pediatric ward. We were almost always treating toddlers for severe dehydration—the result of vomiting and diarrhea. Most of them had picked up a highly contagious bug called rotavirus from contaminated food, feces, or other children. It was easy to spot them, with their sunken eyes and parched skin. They looked desperately thirsty, but were too ill to drink. Unfortunately, the only treatment for most food-borne illnesses was—and still is— fluid replacement and time.
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For Realistic Advice on Healthy Eating, Federal Dietary Guidelines Fall Short
Tweet Share on Facebook February 10, 2011 Comment (4)Quick: How many milligrams of sodium did you eat during the Super Bowl?
If your big game buffet was anything like mine (hot dogs, buffalo wings, fries, and cole slaw), you probably blew through your day’s allowance of sodium in a single meal, according to the most recent edition of the federal government's Dietary Guidelines for Americans. These comprehensive guidelines for healthy eating, which are updated every five years to reflect the latest scientific data, advise that healthy adults and children ages 2 and older consume less than 2,300 mg of sodium per day. Adults over 50, or those with high blood pressure, diabetes, or kidney disease, should consume less than 1,500 mg. Unfortunately, only 1 in 7 of us currently meets those targets; the average American consumes 3,400 mg of sodium per day.
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Healthy Habits Are Hard to Maintain—Even if You Know What Lies Ahead
Tweet Share on Facebook January 27, 2011 Comment (1)"It's about that time of the month," a physician colleague of mine said to me a few days ago, "when our patients start to let go of their New Year's resolutions." That is, all those well-intentioned promises we make to ourselves year after year to eat more fresh fruits and vegetables, to spend 30 minutes in the gym each day, or to start a walking program. Breaking unhealthy habits and starting healthy ones is hard, and most people require several attempts to succeed. As I discussed in a previous blog post, there's good evidence that even multiple intensive lifestyle counseling sessions led by trained professionals are only mildly helpful.
Compounding matters is the fact that every individual is different. You probably know people who’ve lived to ripe old ages in perfect health despite having eaten eggs every day of their lives or not exercising. My great-grandfather smoked cigarettes for 80 years, but died peacefully in his sleep in his late 90s. (Maybe he would have made it to the century mark if he'd quit.) Some researchers have suggested that a more effective way to motivate patients to change their lifestyles could be to give them personalized information about their risk for common chronic conditions such as cancer and heart disease. Others, though, have worried that this knowledge could encourage complacency among those who learn they’re at below-average risk. Why quit smoking, for example, if you think your genes will protect you from lung cancer?
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4 Health Reform Changes to Expect at Your Doctor's Office
Tweet Share on Facebook January 19, 2011 Comment (10)As a family physician, I've gotten used to attending dinner parties where relatives, friends, and sometimes complete strangers ask me about health reform, and how the new law might impact their relationship with their doctor. Unfortunately, because I'm well versed in all the complexities of the legislation, I can't come up with a simple sound bite. But a paper published in the Annals of Internal Medicine last August attempted to explain how the Affordable Care Act is likely to transform the practice of medicine and outlined what changes doctors will need to make in order to provide better care for their patients.
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Worried About Your Lung Cancer Risk? Why a Chest CT Scan May Not Be Wise
Tweet Share on Facebook January 6, 2011 Comment (7)Lung cancer is the leading cause of cancer death in the U.S. and claimed more than 150,000 lives last year. Since most lung cancers are triggered by tobacco use, the best way for family doctors like me to prevent lung cancer in 2011 is to counsel patients not to smoke, or if they already smoke, to quit. Unfortunately, tobacco-damaged lungs often don't heal completely, and ex-smokers continue to be at higher risk for lung and other cancers than never-smokers are.
That's why doctors used to routinely advise that heavy smokers get chest X-rays in hopes of catching cancers at more treatable stages. However, several studies have since found no difference in lung cancer death rates among smokers who got annual chest X-rays versus those who did not. That's likely because the disease is far too advanced to cure by the time it's visible on a chest X-ray.
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Electronic Medical Records: No Cure-All for Medical Errors
Tweet Share on Facebook December 23, 2010 Comment (3)Even though it happened several years ago, I still experience a visceral feeling of guilt and embarrassment when I recall the time I almost prescribed the wrong type of antibiotics for a patient's inner ear infection. As medical errors go, this would not have been that big a deal. Although the medication would have been completely useless for treating her infection, she wasn't likely to suffer serious side effects, or have her condition worsen from a delay in receiving appropriate treatment, since many inner ear infections resolve on their own.
What bothered me about this particular mistake was that I knew perfectly well that oral antibiotics—not eardrops—were the best choice and knew which one to prescribe, but had accidentally clicked on the wrong choice in my electronic medical record system, leading to the wrong prescription being printed. Fortunately, I was able to recognize this mistake before the patient left the office, hurriedly hand-write the correct prescription, and after apologizing, explain the reason for the switch.
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Why Screening for Colorectal Cancer Shouldn't Be a Hard Sell
Tweet Share on Facebook December 13, 2010 Comment (5)Breast and prostate cancer screening tests may dominate headlines, but in terms of the quality of the scientific evidence that early detection saves lives, there are no better cancer screening tests than those for colorectal cancer, or cancer of the large intestine. One in 20 adults will develop colorectal cancer during his or her lifetime, and detecting it before symptoms occur substantially improves a patient’s chances of survival. Nevertheless, 57,000 people in the United States still die from colorectal cancer every year; in fact, more men under age 75 will lose their lives this year to colorectal cancer than to prostate cancer.
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Your Doctor's Role in Helping You Change Your Health Habits
Tweet Share on Facebook December 9, 2010 Comment (2)I once used to see patients in a clinical practice located next door to a popular fast food restaurant. My office hours usually began in the early afternoon and ended about 9 p.m. Whenever I was pressed for time or hadn't packed a dinner, I'd run over to the restaurant to grab a burger, french fries, and soda, and many of my colleagues did the same. As we exchanged guilty looks while sneaking in through the back entrance of the office, I'd often find myself wondering if my counseling patients to eat healthier foods was actually making any difference.
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Your Primary Care Team Will See You Now
Tweet Share on Facebook November 19, 2010 Comment (5)In a previous post about how health reform will change your doctor's visits, I mentioned that you're likely to see your future primary care delivered by a "team" of health professionals rather than your doctor. You might be surprised to hear that "team" is a relatively new concept in family medicine. I once had a colleague who told me, only half in jest, "My definition of good teamwork is that when I tell my office nurse to do something, he or she does it." Personally, I've always favored nurses or medical assistants who excelled at anticipating my needs: those who would prepare a suture tray when a patient showed up with a laceration, for example, or open a urine specimen container for a patient complaining of flank pain and chills.
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In contrast, a high-functioning health team doesn't require doctors to issue orders all the time—or expect nurses to read their boss's mind. These medical assistants can read charts and test results to determine if a patient, say, needs a referral or isn't up to date on an immunization. Medical degrees aren't required for these things, according to a 2004 commentary on health care teams that was published in the Journal of the American Medical Association. If doctors can hand off some of their responsibilities to others on their medical team, this would solve two tough problems in today's medical system. First of all, we're facing a primary care physician shortage that's only going to get worse when nearly all Americans get health insurance in 2014. Massachusetts and California, which already have universal health care systems, have seen severe shortages in pediatricians, family physicians and obstetrician-gynecologists. Medical teams could allow doctors to expand their practices, seeing more patients each day. They could also solve the time-crunch problem where appointment slots in some offices have been reduced to 12 minutes per patient. Nurse practitioners and physician assistants can set aside far more time to discuss lifestyle changes and the side effects of various medications than doctors rushing from room to room.
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