Monday, August 4, 2014

The 15 minute visit to the Doctor's Office

Medical problems can be complex. They have the potential of altering our lives completely and for good and even the power of terminating life. Physicians have devoted a huge proportion of their lives to understand medical issues and to learn the art of palliate if not cure disease. 

Ideally, we should visit a doctor for prevention, advise end general education regarding health problems. The duration of the visit should be determined by the nature of the problem and by the complexity of the tools needed to solve it. Nowadays, in most settings, it is almost impossible to do that. Physicians watch the clock, not because they want to leave and go home, but because there is another patient waiting. And after that patient, there is another and another. All of them can carry problems of similar complexity. Is it fair to squeeze the 13 years of training that a specialist has (not counting the many years of experience after that) into 15 minutes of patient talk? 

An office visit, has the following elements: conversation with the doctor, physical exam, analysis of laboratory values, another conversation to report the physician’s ideas, prescription of medications, ordering further tests, documentation of the encounter and in many occasions, an interaction with the insurance companies to seek approval for certain medications or tests. Is it possible that a good job could be accomplished in 15 minutes?, in 30 minutes? 

This is one of the reasons why the doctor’s office has become a revolving door of patients who come for a prescription refill from a doctor who struggles to keep the practice afloat due to low insurance reimbursements. This is the reason why many complex problems remain unanswered, this the reason why diagnosis can take longer to be achieved and the reason why so many unnecessary  tests are ordered. This is one of the reason of polypharmacy, medication side effects and medication errors.


What can be done? Nothings substitutes good professional advice. This is why, in order to have a question properly answered, the internet should not be used. It should only serve to seek for a good physician. Second medical opinions provided by doctors that devote the proper amount of time to the medical problems are an invaluable tool that will help not only the person looking for the answer, but also the primary care physician who initially did not have the right amount of time to deal with the issue.

Originally posted in the Second Medical Opinions Blog on 7/29/2014

Friday, July 11, 2014

Why a Second Medical Opinion?

The doctor-patient encounter has traditionally been a strict relationship between a physician and the patient requesting the services. However, there were always concerns regarding the cost of the services and how accessible the services were. Starting some decades ago, insurance companies (private and government owned) started to participate in the relationship in an effort to make it more efficient. This had the consequence of spreading the risk and making healthcare more available to people. 

As time passed, healthcare became more dependent on the wellbeing of the insurance programs or companies. In order to be able to provide for all enrollees, the reimbursements to the providers started to decrease and, as a consequence of that, the time that the providers give to the patients also started to decrease (because they had to see more patients in less time so as to pay for overheads and remain profitable.) 

The natural result of this is that people remain with more unanswered questions and more doubts regarding their conditions or diseases. In this current world of gigantic leaps in the development of pharmaceuticals, surgical techniques, gene therapy, amongst others, the explanations that professionals (primary care providers and specialists) need to give their patients are complex. Many patients try to enhance their knowledge by using the internet. This is risky. The internet is filled with unreviewed information posted by un-credentialed people who might confuse or even misguide the patient who needs more answers.


A second medical opinion is a tool that will enable patients to be better informed, to be more reassured regarding their conditions and to bring up the possibility of more educated and effective communication with their doctors. For complex problems, two minds are better than one.

Marco A. Ramos MD

Published originally on the Second Medical Opinions blog on June 10, 2014

Monday, November 18, 2013

Fall Fitness... Enjoy the Season

This article was originally published on October 3, 2013 in KellyJeffreyWellness blog

This time of the year is a great time to get outside and exercise. Many people are taking the time to set some new workout goals. The summer season of traveling with the kids is over and now it is time to focus on your health. 

Cross- Country Running or Walking is a great solo exercise and can be done with friends. The heat of the summer has passed and the fresh cool fall air is a terrific time to enjoy your workouts outside. Both running and walking are excellent activities to help build your muscular endurance.

What about raking the leaves for a classic workout? This is an activity that can be done with your kids or by yourself. Taking just one hour out of your busy day to rake leaves burn close to 400 calories.

Frisbee or Football is another great workout that your kids will enjoy doing with you. Taking just 30 minutes to enjoy this high energy sport is a way to reduce stress and have fun. People can burn up to 300 calories in 30 minutes depending on intensity of course.

Playing a game of basketball in this weather is a terrific way to feel energized and bring out your competitive spirit. You are not only going to give your lower body a workout but your upper body as well.

Mountain Biking is a way to enjoy nature and puts less stress on joints then other activities. It is a great way to build endurance levels and torch calories quickly. It works your quads and gluts as you cycle your way up hilly areas.


I hope you all feel the energy of fall and enjoy some of these wonderful outside exercises.
Have a Blessed Season
~~~ Kelly Jeffrey

This post is reproduced from KellyJeffreyWellness blog with permission from Kelly Jeffrey, the author.




Saturday, August 17, 2013

Presión Arterial Elevada y Exceso de Sal en la Dieta

Foto: Steven Fruitsmaak

La presión arterial elevada o hipertensión arterial es una condición medica conocida por causar problemas de salud por milenios. Sin embargo, el conocimiento científico adecuado y las mediciones apropiadas empezaron a acumularse sólo hace aproximadamente 250 años. La manera que conocemos actualmente de medir la presión fue desarrollada hace aproximadamente 100 años. Los últimos 30 años han sido testigos de importantes desarrollos farmacológicos que se han usado y han reducido la cantidad de ataques al corazón, accidentes cerebrovasculares y enfermedad renal. Se han hecho también descubrimientos en el área genética que explican ciertos tipos de hipertensión en algunas personas.

El incremento del uso de sal en la comida (como preservante y saborizante) y el éxito de la industria de comida rápida ha incrementado el promedio de sal que las personas ingieren cada día. En los Estados Unidos, este promedio es 3450 mg de sodio diarios, que es mucho mas que el máximo recomendad de 2300 mg al día.

¿Cómo es que el exceso de sal incrementa la presión arterial? ¿Como prevenirla?

El cuerpo humano trata de mantener la concentración de sodio en la sangre cerca de a 140 mEq/L. Si una persona ingiere una comida salada, tiene que tomar agua para diluir la concentración de sodio en la sangre. Cuando esto ocurre, el volumen total de fluido en las arterias y venas se incrementa. Parte de este fluido sale de los capilares al espacio intersticial entre las células. El riñón detecta este incremento del fluido y manda señales que incrementan la presión arterial en un intento de regular el exceso de fluido en el cuerpo. Si una persona mantiene la presión elevada por mucho tiempo, el corazón tiene que trabajar mas fuerte, las arterias se vuelven mas gruesas y propensas a desarrollar placas de aterosclerosis, incrementando de esta manera el riesgo de accidentes cerebrovasculares, infartos al corazón y enfermedad renal.

El éxito de los diuréticos en el tratamiento de la presión arterial elevada se debe en parte al efecto que tienen cuando facilitan la excreción de sal a través de la orina. Otros medicamentos se enfocan en dilatar las pequeñas arterias y en bloquear la acción de sustancias que elevan la presión. Algunos pacientes padecen de enfermedades genéticas que hacen esencial el uso de determinados fármacos. Otras personas tienen las arterias endurecidas y dependen de medicinas para mantener la presión a niveles aceptables. Sin embargo, la mayoría de personas, especialmente jóvenes se beneficiarían limitando la cantidad de sal en la dieta. Hacer esto, reduciría los cambios que se producen en el corazón por bombear sangre en contra de presiones elevadas y se reduciría el endurecimiento de las arterias.

Lograr una Dieta Baja en Sal no es tan Complicado

Como lograr una dieta baja en sal? Ante todo, el objetivo está en mantener el consumo de sodio por debajo de 2300 mg. La clave se encuentra en monitorear lo que se come. A la hora de comprar comida, se debe leer la información nutricional del producto. En caso de no encontrar la información de manera rápida, se puede obtener del internet. Una manera sencilla de evitar el exceso de sal es evitar comidas procesadas, comida de restaurante, comida rápida y evitar el uso del salero. Así mismo, incrementar el consumo de frutas y vegetales ayuda a disminuir la cantidad diaria de sal ingerida. Un ejercicio interesante que invito a hacer es el de construir un diario dietético por una semana. Así se puede calcular el promedio de sodio ingerido por día. Si hay más preguntas, se debe consultar con su doctor.

Saturday, August 10, 2013

Elevated Blood Pressure and Excess Salt in the Diet


Picture by Steven Fruitsmaak
Picture by Steven Fruitsmaak
High blood pressure or hypertension is a medical condition known for thousands of years to cause health problems. However, proper scientific knowledge and measurements started to be gathered about 250 years ago. Our current way of measuring blood pressure was developed about 100 years ago. The last 30 years has seen  major developments in medications used to treat blood pressure, showing benefits by reducing heart attacks, strokes and kidney disease. In addition, discoveries have been made in the genetic area that explain certain types of hypertension that affect some people.

The proliferation of salt additives in foods (for preservation and taste purposes) and the success of the fast food industry has increased the total amount of salt that people ingest as an average. In America, this average is 3450 mg of sodium per day. This is much more than the maximum recommended amount of 2300 mg of sodium per day.

How does Excess Salt Increase Blood Pressure? Can We Prevent it?

The body will always try to keep the concentration of sodium in the blood close to 140 mEq/L. If someone eats a salty meal, he or she has to drink water to a point that the sodium concentration would not increase. When doing this, the total volume of fluid within the veins and arteries increases. Some of this excess fluid leaks out into the interstitial spaces in between the cells. The kidneys sense this excess body fluid and send signals to increase the blood pressure in an attempt to regulate the excess body fluid. If a person keeps a state of elevated blood pressure for a long time, the heart has to work harder, the arteries can become thicker and prone to developing atherosclerotic plaques, therefore increasing the risk of strokes, heart attacks, and kidney failure.

The success of diuretics (water pills) in treating elevated blood pressure in part has to do with the effect of helping the kidneys remove the excess salt. Other medications focus on dilating arteries and blocking the action of substances known to elevate the blood pressure. Some patients have certain genetic conditions that make the use of medications essential. Other patients already have hardened arteries and depend on medications to keep the blood pressure at a healthy level. However, the majority of people, specially young people would greatly benefit from limiting the amount of salt in their diets. By doing this, they will reduce the changes of the heart pumping against harder pressures and would keep arteries less hardened. 

Achieving a Low Salt Diet is not so Complicated

How to achieve a low salt diet? First of all, the goal would be to keep the intake lower than 2300 mg. The key thing to do is to monitor what is eaten. Foods have nutrition facts that should be read prior to buying food. A simple way of achieving a low salt intake is to shift away from processed food, restaurant food, fast food and refrain from using the salt shaker. in addition to this, is to increase the amount of fruit and vegetables in the diet. An interesting exercise that I invite you to do is to construct a dietary diary for a week that includes every food, drink and snack eaten. Using this information, the average daily salt intake can be calculated. The internet can be used for finding the salt content of foods. If you have further questions, contact your primary care physician.

Please Like us in Facebook and follow us on Twitter. By doing so you will get updates and notices of new posts.