Sunday, June 21, 2015

Top 10 Reasons to Have an Established Primary Care Physician (PCP)

10.  Yearly physicals starting in your 30s or 40s can discover an asymptomatic serious medical condition, a cancer (remember the famous Seinfeld episode about a dermatologist saving a life due to skin cancer), or a lab abnormality indicative of a vital organ problem.  Knowledge is half the battle.  

9.  The Emergency Department (aka the ER) and an Urgent Care Clinic (aka a Doc in the Box) are your only other alternatives when you develop a symptom or illness that requires a visit to the doctor.  ER physicians are trained to take care of emergencies NOT your chronic migraine headaches.  

8.  Blood pressure, cholesterol, diabetes, and smoking are some of the biggest causes of heart disease and stroke in the US.  The first three generally do not cause symptoms and the fourth one is rooted in addiction and denial.  Let your PCP screen you for these so that you don’t leave this world too soon.  

7.  Whether you like it or not- starting at certain ages and at pre-specified intervals, all patients need colonoscopies, prostate cancer screening (men), and pap smears/mammograms (women).  All of these cancers can either be prevented or cured if found soon enough.  Those of you who keep putting off your screening clearly need to have a PCP set up a yearly schedule.  

6.  Some insurances require a PCP in order to be referred to a specialist.  Think about needing an urgent referral to a cardiologist for chest pain or to a surgeon for a bad gallbladder.  Having an established PCP allows you to have faith in this referral.  Otherwise you will be playing Russian roulette with the yellow pages. 

5.  Colds, coughs, and sore throats usually just go away without treatment, but they sometimes can turn into something more.  Let your doctor diagnose: a simple urinary tract infection before you are hospitalized with pyelonephritis/sepsis (a full blown kidney infection), strep throat before it turns into rheumatic heart disease, your cough and shortness of breath as a walking pneumonia before you end up on a ventilator for it.

4.  Although the author of this list disagrees, PCPs are a good place to start when you think you need an antibiotic or a pain killer.  

3.  Whether you believe in vaccines or not, you need a pediatrician or family practice physician to guide you through the important details of your child’s health.  The Internet is a very dangerous resource for this topic.  

2.  Think of your PCP as your health coach or teacher.  He/she should give you the best advice about all matters involving your health.  You can depend on him/her to treat you (or refer you) for things like back pain, chest pain, headaches, etc.

1.  Remember that your PCP is going to be your gateway into the medical world.  Think of him/her as a general contractor for your body who has a Rolodex of subcontractors if needed.  If you have a bad PCP, you are more likely to be treated less aggressively/appropriately and referred to poorer quality specialists.  Love your PCP!

David Jones is the owner/blogger at and a private practice cardiologist.  

The Problem with Healthcare Ratings Sites

The internet is such a fabulous medium with unlimited possibilities and the ability to seemingly find any piece of information on any topic in the universe.  American healthcare is one of the largest expenditures by GDP in this country, and thus is also one of the most discussed and debated sectors from a professional, personal, financial, and societal standpoint.  Physicians are at the epicenter of this debate and their professional reputations are in the crosshairs.  Patients (like consumers in other sectors) drive the discussions about doctors in social circles as well as water cooler diatribes.  A patient’s choice of physician can be as simple as a good recommendation from a colleague at the office coffee pot on Monday morning or on the 18th green on Saturday afternoon.   

We all know that gossip, opinion, and innuendo should not sway important life decisions which is why healthcare/physician ratings websites seem like SUCH a great idea.  Patients rate their doctors by quality, experience, knowledge, personality, availability, and bedside manner.  All is happy in the world as the sun sets onto a rainbow and the story ends…

Should a site like this have all of the qualities listed in the prior paragraph?  Absolutely.  Should patients have access to this data at the tip of their fingers?  Positively.  Is this type of site available now?  Negativo.  

Unfortunately, what should be a very popular way of rank ordering physicians by specialty on every mobile device, laptop, and desktop in the US so that consumers can make an informed decision IS a big mess of disordered ratings with bias, low numbers leading to unknown significance, and poor relevance to the general public.  Take it a step farther and one should be able to subdivide the good/great physicians by personality type, work ethic, peer esteem, etc. to sync up patients with preferred characteristics.  Undeniably, the availability of this type of site could change the way patients access their healthcare and ease tough decisions.  

The biggest issue with the current milieu of healthcare ratings is that the most popular ones out there are no different than your typical site that rates plumbers and electricians.  The bottomline is that the people who know doctors and hospitals best are not involved in the ratings process.  Other doctors, nurses, and healthcare workers should know the lay of the land better than even the most informed patients.  Someone recently commented to me that no one knows medicine doctors better than ICU nurses and no one knows surgeons better than operating room techs and nurses.  I believe it.  

Now we have to be careful not to make this a popularity contest, but the addition of peer ratings to patient ratings is a HUGE step in the right direction. gives doctors, nurses, and patients the ability to rate anonymously or publicly. 

There are several challenges to this approach as doctors are historically as likely to participate in this type of process as a preacher is to be seen at a gentleman’s establishment.  Unfortunately, we cannot give physician’s incentives to rate each other for fear of bias.  However, physician satisfaction scores have now moved into a prominent role and are poised to determine a percentage of a doctor’s reimbursement in the future.  For this reason, DoctorRated thinks that physicians as a whole should embrace peer ratings and take control of the ratings sector.  The nice thing from a physician standpoint is that once you spend the time to rate your referring doctors, you should have minimal maintenance to do to keep your preferences accurate.  

Patients also do not seem to be interested in rating doctors as evidenced by the low number of ratings per doctor on the popular sites.  DoctorRated thinks the reason for this has to do with “the out of sight, out of mind” philosophy.  We need to attract patients to rate while in the doctor’s waiting room or on the way out of the office.  Otherwise, this may never gain traction.  Our hope is that you will start seeing DoctorRated signs in waiting rooms and given cards on your way out of the office.  

With some momentum, DoctorRated is poised to give the medical community and society a useful tool to help patients and doctors improve their healthcare decisions.  

David Jones is the owner of and a private practice cardiologist.  

Thursday, June 18, 2015

How to Pick the Right Emergency Department

Regardless of age or gender, all patients will inevitably need emergency care at one point in their life or another.  I am often asked by friends and family members how to pick an Emergency Department (ED).  I usually give them my response and they sometimes will say:  “the wait time is too long”… “the ED physician did not give [a relative] enough attention last time”…  “the seats at [local hospital] are so uncomfortable”… “can you believe that [so and so] was sent home without pain medication?”… etc.  Although these explanations are certainly valid, this article is meant to point out that there is more strategy to an ED visit than a wait time, an uncomfortable chair, and sedative medications. 

Tuesday, June 16, 2015

Life's Second Childhood

Life can start as a whirlwind and end up a boomerang.  

You get your big break in life as an infant/toddler under the tutelage of your parent(s) who coddle you and raise you in their shadow.  All of your needs are filled and all of your decisions are quietly watched and judged.  You have little to worry about because they make most of the important decisions and allow you to drift happily through life while feeding and growing like the plant outside your bedroom window.  In the boomerang analogy, this is the initial flight just after leaving the hands of the thrower.  

Sunday, June 7, 2015

Reading a Patient's Poker Face- the Complex Psychology Behind Every Patient-Doctor Interaction

Patient-doctor communication often has many facets, wrinkles, and twists.  Medical school prepares a doctor minimally for the ups and downs of these patient interactions.

  There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient.  On the job training is sine qua non.  

During and after medical school, it took me several years of practice to hone my skills as a communicator.  I learned some lessons the hard way.

Friday, June 5, 2015

How to Pick a New Primary Care Provider (PCP)

I want you to think about your choice of Primary Care Physician (PCP) as one that is vital to your health and happiness- similar to your choice of church or school and just short of your choice of spouse.
Your choice of PCP can determine life or death because the PCP is your gateway to healthcare. Primary care physicians are on the front line and treat disorders varying from depression and anxiety to high blood pressure and cholesterol. They are usually the first to suspect stroke and heart disease and often will be the ones who discover cancer and other life-threatening diseases.

Wednesday, June 3, 2015

The Steady Domination/Destruction of Medicine

Doctors (and nurses for that matter) can be as tough as the nail that holds up the shingle hanging over the office door.  
Up all night with no sleep… “No problem”  
No help from partners or other doctors..“I’ll just have to work harder”  
No weekends off for [insert a number] months… “It builds character”
Haven’t seen my spouse or kids in a couple of days… “I’ll try to see them this weekend”

Let’s face it.  By most accounts, the healthcare lifestyle is not ideal for a social life nor for a family life.  Spouses and significant others tend to run in packs due to lack of maintenance and kids don’t always recognize the doctor parent for lack of attentiveness.  Although not all practice situations are the same, the average physician is overworked by the American standard.  Days and on-call nights are long, weeks and months can grind on in perpetuity, and it takes a toll on the body/mind/soul.  Yet medical and nursing schools are still seeing adequate applications and residency programs are still cranking out hard-working men and women after their apprenticeships.  

Monday, June 1, 2015

What Do Dr. McDreamy, The One-Eyed Guy Behind the Curtain, and George Clooney Have in Common?

What is a doctor rating and why are doctor ratings sites important for doctors and for patients?  Before Al Gore and the invention of the internet

(I know…I know…the two have nothing to do with each other except that one opened his mouth while the other was spawned), there were no doctor ratings.