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Incontinence Support Blog

Reducing Waste in Health Care

Posted by Mens Liberty

Dec 10, 2013 2:30:00 AM

Experts estimate that 30% of the $2.3 trillion spent on health care is wasted, meaning it could be eliminated without reducing the quality of patient care. But before this waste in our health care system can be eliminated, it must first be identified -- where it is, why and how much.

Categories of Waste

  • Failures of care delivery.
    This category includes poor execution or lack of widespread adoption of best practices, such as effective preventive care practices or patient safety best practices. Delivery failures can result in patient injuries, worse clinicaloutcomes, and higher costs.
  • Failures of care coordination.
    These problems occur when patients experience care that is fragmented anddisjointed--for example, when the care of patients transitioning from one caresetting to another is poorly managed. These problems can include unnecessary hospital readmissions, avoidable complications, and declines in functional status, especially for the chronically ill.
  • Overtreatment.
    This category includes care that is rooted in outmoded habits, that is driven by providers' preferences rather than those of informed patients, that ignores scientific findings, or that is motivated by something other than provision of optimal care for a patient.
  • Administrative complexity.
    This category of waste consists of excess spending that occurs because private health insurance companies, the government, or accreditation agencies create inefficient or flawed rules and overly bureaucratic procedures. For example, a lack of standardized forms and procedures can result in needlessly complex and time-consuming billing work for physicians and their staff.
  • Pricing failures.
    This type of waste occurs when the price of a service exceeds that found in a properly functioning market, which would be equal to the actual cost of production plus a reasonable profit. For example, Berwick and Hackbarth note that magnetic resonance imaging and computed tomography scans are several times more expensive in the United States than they are in other countries, attributing this to an absence of transparency and lack of competitive markets.
  • Fraud and abuse.
    In addition to fake medical bills and scams, this category includes the cost of additional inspections and regulations to catch wrongdoing.

 

How can we reduce this waste?

  • Improve providers' capacity to collect and use digital data to advance science and improve care.
  • Involve patients and their families or caregivers in care decisions. Increasing comparative effectiveness research may help physicians, patients, and their families make more informed decisions.
  • Use clinical practice guidelines and provider decision support tools to a greater extent.
  • Promote partnerships and coordination between providers and the community to improve care transitions.
  • Realign financial incentives to promote continuous learning and the delivery of high-quality, low-cost care.
  • Improve transparency in provider performance, including quality, price, cost, and outcomes information.

As always, thanks for reading and if you have any thoughts or suggestions on how we can help to reduce the waste in health care, feel free to leave a comment.

*REFERENCE: Health Affairs

Topics: Interesting Articles, healthcare professionals

A Caregivers Lesson in Asking for Help, a Personal Story

Posted by Sarah Woodward

Nov 24, 2013 10:31:00 AM

Ask any caregiver to describe their scariest moment, and I will bet you, none of those moments will be about them. That's the thing about being a caregiver for one of your loved ones – mother, father, sibling, husband, child – their illness, their comfort, their happiness become your own. Yet there are no doctors, or specialists or medications for you. It's often a lonely and thankless task.

But don't think for a moment that we regret it. I know I don't. I spent three years as a full time caregiver for my younger sister. It was by far the hardest thing I've ever done. It took over my life and ate away at my personal time, my finances, my social network, my job. It all suffered under the strain of caring for someone who was unable to take care of herself.

My sister, let’s call her L, has several mental health challenges, including but certainly not limited to bipolar disorder. This meant a lot of different things – basically, L has intense rapid mood swings between manic euphoria and extreme depression. L has been hospitalized 10 times in the last 8 years for suicide attempts, including one which ended with her in a coma in intensive care for 4 days before regaining consciousness.

Back in 2010, I moved home after many years to take care of her after her latest suicide attempt. L shunned my parents support yet wasn't able to live independently, she couldn't even be trusted to take her medication without supervision. So I moved home, got an apartment and moved her in with me.

To say I had no idea what I was getting myself into is an understatement. I could give you a rendition of everything that happened in the next two years, but to honest that would be a book, not a blog post. So I'll just give you an excerpt –

My lowest moment as a caregiver was spent sitting in the psychiatric ER waiting room. I've never been more terrified than I was that night. Because I'd failed; everything I'd spent nearly a year working on was coming apart around me. It was my job to take care of her, to protect her and I failed. I couldn't protect her from the one thing that truly endangered her, herself.

The night began shortly after I got home from work, with L coming into my room crying, holding a paring knife. She was mumbling about the voices and keep trying to cut out her own eyes so that she could “get to the voices” that were trying to make her think she was crazy.

My first challenge was to get the knife away from her without getting hurt – it took a few minutes but eventually she dropped it and collapsed on the floor crying and rocking, seemingly unconcerned that she was repeatedly knocking her head into a wall. I cradled her and tried to get her to take her meds, to help calm her.

After nearly 20 minutes of this, I was getting even more concerned – I had never seen L like this before. The meds weren’t kicking in yet. I focused on calming L, holding her and speaking softly, telling her I loved her and eventually just begging her to calm down. It took about half an hour and the meds finally kicked in and she calmed. The crying stopped. But now she was withdrawn, she seemed terrified of me. She shrank to the other side of the room, convinced that I was working with the evil woman who put the voices in her head that I was trying to hurt her.

It took me another hour to convince L to go to the hospital. And that was how I found myself sitting in a waiting room, waiting for a doctor to come out and tell me that I had failed, that there was something I could have or should have done to prevent this. I find it hard to find words that adequately convey the level of guilt I felt. I was a failure at the only thing
that really mattered.

But he didn't. The only thing he said was that I should have called an ambulance; that I shouldn't have had to deal with this on my own. Where were my parents? I was barely older than L was. I didn't have an answer for him. Asking for help has never been my strong suit. It seemed like weakness. Taking care of L was my responsibility – why should I expect anyone else to help?

It's been several years now, but I can still recall every detail of that night, the feelings of guilt, of relief that L was admitted, that I could go home to a quiet apartment. Though I love L, in that moment, I didn't like her very much, and I resented her. I resented what I had given up
for her, seemingly all for nothing.

But the truth is, it wasn't for nothing. Because the next day I got up and went back to hospital, and again the day after that, and the one after that. Eventually, L came home. And while I can't say everything was better (it definitely wasn't), the feelings of failure abated, the guilt lessened. L lives on her own now. I don't know how much of that was because of me, but I take some small measure of comfort for having done something in my life that I know has truly mattered to another person.  

And in the years since, the doctor's words have stuck with me. And in time, I learned something that I hope I never forget: needing help doesn't make us weak, the ability to ask for help, to be vulnerable, is the very definition of courage. I'm not perfect, no one is, certainly no caregiver. We need to be forgiven our failings, just like anyone else. But we also need to be courageous enough to ask for help – from doctors, from family, from friends. We can't do it all alone.

This November is National Family Caregivers Month. It's about recognizing the important role of caregivers – for anyone who has sat in that waiting room, counted pills and scheduled doctor’s visits, done the shopping and cleaned the house, provided physical, social, psychological or other assistance in the daily life of a loved one. Please know... there are thousands of other people out there with issues just like yours. Ask for help, ask for support. You deserve it and so does your loved one.

Enter to Win a Respite  Spa Day for Caregivers!

Topics: family, Caregiving, healthcare professionals

Infection Prevention and You

Posted by Mens Liberty

Oct 28, 2013 3:00:00 PM

International Infection Prevention Week (IIPW) ended last week, but that doesn’t mean we can slack off for the next 358 days. Let’s stick with the mission statement developed by APIC: 365 days of commitment, 7 days of focus. In fact, we would like to take a moment to give a shout out to the Association for Professionals in Infection Control and Epidemiology (APIC) and Eloquest Healthcare Inc.  Both of these organizations are making great strides in order to reduce the number of infections contracted by healthcare patients.

Infection Infographic

Topics: Caregiving, healthcare professionals, urinary tract infections, hospital acquired infections, Eloquest

Fear & Medicine, a Lesson for Healthcare Professionals & Caregivers

Posted by Sarah Woodward

Sep 30, 2013 9:55:00 AM

Today I wanted to share a blog from Danielle Ofri of Slate.com, a MD and PhD, who wrote a moving story about fear and medicine. And it spoke to me, although she wrote as a mother, I know a very similar fear as a caregiver. Trusting our loved ones to a complicated system, filled with jargon we may never truly understand requires a leap of faith that anyone who hasn't walked a mile in our shoes will probably never understand.

So take a look, does any of this sound familiar to you? Do you have a story to share? Let us know!

Orange Line

When my son was 18 months old, his doctor recommended that he get tympanostomy tubes in his ears because of recurrent ear infections. He might not be hearing clearly during this critical stage of language development. Being a physician myself, I researched this thoroughly. It turns out the evidence supporting the procedure is slight—it may help with hearing and language, but all kids seem to catch up whether or not they had the tubes.

In the end, though, I made my decision more as a parent than as a doctor—I wanted my child to have the best opportunity for language development, and besides, it was a low-risk  procedure.

Two weeks later I scooped my sleeping boy out of bed before dawn, buckled him into his car seat, and hailed a taxi on the darkened city streets. At the hospital, my son snuggled in my lap as I sat on a recliner that was wheeled into the OR. Everyone was cheerful and friendly. The nurses sang songs, and the surgeon pointed out the elephants on his hat. I was given a hose with anesthetic to wiggle in front of my squirming son, to sedate him enough for the staff to get him onto the table.

We played with the hose for 10 minutes. Just when I thought that this technique would never succeed, my son slackened slightly, lolling his head against my chest. At that moment, the OR staff clicked into action. The cheery demeanor dissolved and everyone was all-business. The patient was whisked from my arms and in less than three seconds he was strapped on the table with a mask over his face, preternaturally still, unhumanly still.

At that moment, my faith in science plummeted from beneath me. My decades of medical training, my Ph.D. in biochemistry, my grounding in the scientific method, all evaporated in the blink of an eye. The sight of my son—stone-still on the OR table, deathly rigid—completely unhinged my confidence that “everything would be OK.” Suddenly, I was not sure that anything would be OK. My little baby—23 pounds including race-car pajamas and diaper—was minuscule and fragile under the ministrations of five lumbering adults and gargantuan, stainless steel equipment. And there was nothing I could do to help him.

An orderly began to lead me out of the OR, and suddenly I stopped and clenched onto his arm. “Please,” I beseeched him. “Please make sure my son is OK.” He nodded and reassured me, even though he had no role at all in the surgery. But he was wearing blue scrubs, so to me he was somehow part of the frightening medical complex that had swallowed up my son.

I paced the waiting room, the knot in my gut twisting painfully. What if something bad  happened? Adverse outcomes were rare for this procedure—I knew that—but when a procedure is performed frequently enough, rare occurrences will eventually happen. I circled the waiting room stiffly, nursing my guilt.

When the surgeon appeared without my son in tow, my heart stuttered to a standstill. I steeled myself for the bad news. “It’s done,” he said with a shrug. “He might be a little cranky when he wakes up, but everything went fine.”

It took some time for the reality of his words to sink in. Even when a sleepy, tousled boy was placed in my arms, the panicky choke of fear still gripped me. I have always been a rational person, confident in the power of facts. Knowledge armed me against the existential fears of the universe. Yet here I was facing a minor surgical procedure, and all of my armor crumbled in a heartbeat. My heart ached for parents whose children are truly ill, for the frightening bargain of uncertainty they must make as they entrust their children to the medical system.

It is as though there is a precipitous drop in front of you, but a Plexiglas bridge extends across the void as in the classic behavioral psychology experiments. The medical system beckons, “It’s safe. We’ll guide your child across the glass bridge.” But your emotions, your life experience,
your gut, and your eyes can only see the sheer drop. 

Cradling a restless boy in my arms, it suddenly dawned on me that we ask patients every day to step over this void, to trust in the system. In matters both small and large, we ask them to step onto a glass bridge, reinforced only by our assurances. Even if they are able to  intellectually evaluate the risks and benefits, at some point they have to make an all-or-nothing decision whether to cross that bridge.

My son recovered rapidly—he was into trouble before lunchtime—but my emotional vulnerability lasted far longer. I’m still an empiricist, and still hold strong faith in the power of the scientific method, but now I appreciate now quickly and resolutely this armor of rational protection can dissolve.

When I sit with a patient now, deciding on a treatment, I still lay out the risks and benefits as systematically as I can. But then I take a moment to acknowledge the raw fear that cannot be assuaged by even the most convincing clinical data. This conversation can’t eliminate the necessary leap of faith. But at least there is some recognition of the stomach-plummeting sensation that occurs when the patient edges their toes out onto that clear glass bridge.

Danielle Ofri is an associate professor of medicine at NYU School of Medicine and editor-in-chief of the Bellevue Literary Review. Her newest book is What Doctors Feel: How Emotions Affect the Practice of Medicine.


 

Topics: family, urinary management, doctors visit, Caregiving, healthcare professionals

Defeating Stigma in Healthcare Award for 2013: Rick Rador, MD

Posted by Sarah Woodward

Sep 16, 2013 9:19:00 AM

We're thrilled to get to share some news from the Simon Foundation for Continence.  They recently announced Rick Rader, MD, as the 2013 Defeating Stigma in Healthcare Award recipient. Dr. Rader is the Director of the Morton J. Kent Habilitation Center at the Orange Grove Center (Chattanooga, TN), a nationally known community agency supporting the needs of individuals with intellectual and developmental disabilities.

Rick Rader, MD, as the 2013 Defeating Stigma in Healthcare AwardRader was presented the Defeating Stigma in Healthcare Award at a Black Tie Gala April 12th in Chicago. The Gala marked the conclusion of a year-long celebration of the 30th anniversary of the founding of The Simon Foundation for Continence in 1982. This event attracted an international audience of guests, including participants from Japan, Australia, Denmark, New Zealand, Brazil, Canada, England, Sweden, Ireland, Germany, the Netherlands, and Israel along with individuals from throughout the USA.

“Our organization was delighted to surprise and honor Dr. Rader for his tremendous efforts to reduce stigma in healthcare with the 2013 Defeating Stigma in Healthcare Award. Stigma negatively impacts the quality of life of individuals with conditions such as cancer, AIDS, and incontinence; conditions that sadly yet today, cause so many to fear being marginalized by society. It is impossible to overestimate the impact of stigma,” stated Cheryle Gartley, President and Founder of The Simon Foundation for Continence.

Dr. Rader trained as an internist and is a medical futurist, responsible for the creation of innovative healthcare programs addressing the challenges of aging in the marginalized population he serves. He lectures frequently on stigma and its impact on healthcare access for compromised and underserved patient populations. Dr. Rader’s outreach includes: Editor-in-Chief of Exceptional Parent Magazine; over 300 articles published in the arena of disabilities; past president of the American Academy of Developmental Medicine and Dentistry; consultant to four Surgeon Generals; adjunct Professor of Human Development at the University of Tennessee; an appointment to the National Academy of Practice in Medicine as a Distinguished Practitioner; Founding President of the American Association on Multi-Sensory Environments; Emeritus Advisor to the Agency for Healthcare Research and Quality at the US Department of Health & Human Services in the area of Healthcare Innovation; and co-founder of Label Me Not, an organization working to defeat stigma.

In accepting the Defeating Stigma in Healthcare Award, Dr. Rader, who began his career as a medical anthropologist, told the audience that the stigma he observed as an anthropologist led him to his career in medicine. Stated Rader: “According to Goffman, [sociologist] stigma spoils an individual’s identity; and in doing so it also robs him/her of their visibility. It is this rendering of a person’s invisibility that relegates them to injustice and often removes them from mainstream healthcare. The medical, nursing and therapy community is often the worst offenders. This award from the Simon Foundation is greatly appreciated and is deserved by all of us in the daily throes of supporting and protecting vulnerable individuals. It serves to inspire me to work harder, work longer and work smarter along with my colleagues in the defeat of misguided healthcare stigma.”

Congratulations Dr Rador, and thank you for all your work!

Eliminate the Stigma  of Incontinence

Topics: healthcare professionals, diaper alternatives

Losing my temporarily able-bodied status, one physicians story

Posted by Sarah Woodward

Aug 17, 2013 9:57:00 AM

Today I wanted to share this amazing post from physician Sandra Shea. Originally posted over at the awesome KevinMD.com, she has a powerful reminder to share about how we think about our bodies and about people with physical disabilities like spinal cord injury.

--------------------------------------------------------------

I thought of Peter when I lost my TAB status.

I lost it on vacation. These things happen. Suddenly, one Friday night in Florida, I was no longer a TAB. Shouldn’t have been too surprised, I guess.

But I didn’t expect it would involve a chicken.

I should explain.

I’m a medical educator: I have a PhD in experimental psychology/neuroscience, and I teach first-year medical students. In our curriculum, the students work through patient cases that are grouped by organ system. At the end of each case, we have a wrap-up in which we highlight the case’s diagnostic features and answer any student questions. Most of these discussions are faculty-led, but occasionally they’re run by a patient whose history mirrors the case we’re studying. Peter was one of these.

Like the patient in one of the neurological cases, he had fractured his spine in a diving accident. In a matter of seconds, he’d been transformed from a typical teenager to a tetraplegic (someone paralyzed from the shoulders down), although he retained some motion in one arm.

Peter opened his sessions by telling the students that he would answer any questions they had about any aspect of his condition.

“The doors are closed, but your curiosity should be open,” he’d say.

Each year they’d start hesitantly, but eventually move into delicate questions that ranged from how bowel movements were completed to how he participated in sexual activities, and with each question he and they developed a stronger tie. Peter would answer their questions quickly and candidly (even when they asked his opinion of physicians).

Then, one day, a question stopped him cold.

“I was wondering about the terms we see applied to patients with spinal-cord damage,” a student said. “Do you prefer ‘handicapped,’ ‘crippled’ or ‘disabled’? Does it really matter?”

Peter paused, flushed, bit his lip and took a deep breath.

“Yes,” he said. “It does matter. Some of my colleagues prefer the term ‘disabled’ to ‘handicapped,’ but I have no strong preference between those two. I would, however”–he nudged his electric wheelchair forward–”strongly emphasize that I and most of the people I know would like the word ‘crippled’ removed from the language.”

He paused and looked around.

“The word carries demeaning and perhaps hateful connotations. To many, calling someone ‘crippled’ is the same as putting the person in a box, sealing it and tossing it away. The other terms imply a process, not an ending. And you TABs just don’t quite get the difference.”

The students looked at one another; whispers ran through the room.

Peter smiled.

“Yes, TABs. You’re all TABs,” he said, “except you.” He nodded at a young woman in the front row, her foot encased in a walking cast.

“What do you think a TAB might be?” Peter asked.

We all just looked at him.

“Temporarily able-bodied,” he said.

“If you think about it,” he continued, “being able-bodied might be all that you know. You’ve always gone where you wanted when you wanted and not been slowed by injury or disease. But that doesn’t mean you’ll stay that way. Someday you’ll probably need crutches or a cane, or be in a wheelchair for a little while or maybe for the rest of your life.”

There was a thoughtful silence.

Then one student spoke. “So it’s sort of like the Sphinx’s riddle in Oedipus Rex: ‘What is the creature that walks on four legs in the morning, two legs at noon, and three in the evening?’ The answer is a human being. A human being crawls as a baby, walks at midlife and uses a cane when elderly.”

“I’ve never thought about it that way,” Peter said. “But yes, in a way, that fits.”

A few years later, Peter died after a series of strokes. He was not yet fifty.

I thought of him as I sat in the Key West emergency room, waiting for a pair of crutches and a thigh-to-calf knee brace.

My injury had come about earlier that day, as I was stepping down from some uneven stairs onto the sidewalk. Nearby, a hen and her chicks were foraging. Descendants of the fowl bred here long ago for cockfighting, they were part of the population of chickens that runs loose on the island. The local lore has it that, since Key West is a bird sanctuary, the chickens can’t be harmed.

A skateboarder heading along the sidewalk must have taken that to heart; he ducked around the hen and rolled directly into my path.

Stepping back up the stairs to avoid a collision, I slipped, landed with all my weight on my turned leg and felt something slide and something tear. The slide was the kneecap dislocating, and the tear was later revealed to be the posterior medial meniscus, the knee’s cartilage “shock absorber.”

Some months from now, after surgery and rehab, I hope to regain my TAB status.

But even as I put away my crutches, I hope I’ll never put away my memories of Peter, his generous spirit, and all of the lessons he taught.

Sandra L. Shea is an associate professor, department of family and community medicine, Southern Illinois University School of Medicine.  This piece was originally published in Pulse — voices from the heart of medicine

Topics: doctors visit, healthcare professionals, spinal cord injury

7 Medical Procedures You May Not Need...

Posted by Sarah Woodward

Jul 19, 2013 10:20:00 AM

You're facing minor surgery, and your doctor orders routine preoperation tests. Do you get them?

You're a senior with insomnia. Prescription sleeping pills are OK, right? You see an ad for a screening to detect a potential stroke. Good idea?

Probably not, the experts say. All three are among the unnecessary or potentially harmful tests and treatments identified by 17 key medical specialty societies, which recently, in Washington, released their lists of questionable procedures as part of the Choosing Wisely campaign.

That campaign, set up by the nonprofit American Board of Internal Medicine (ABIM) Foundation, began in 2012 when nine medical societies first offered their lists of unnecessary treatments.

Consumer Reports is a partner in the Choosing Wisely campaign, and John Santa, M.D., who directs that group's health ratings, says, "We know Americans believe more health care is better, and all prevention is good." But, he stresses, "waste and overuse is a major issue — and it's frequent across all medical disciplines."

Christine K. Cassel, president and chief executive of the ABIM, says the Choosing Wisely campaign is "about the right care at the right time for the right patient."

Here are seven overused tests or treatments commonly prescribed for people age 50-plus that experts now say you probably don't need if you're healthy.

1. Recommendation: Avoid routine presurgery tests for eye and other low-risk surgeries (American Society for Clinical Pathology and American Academy of Ophthalmology).

Men and women facing elective surgery — eye, foot and cosmetic operations, as well as biopsies — routinely undergo unnecessary blood and other tests. "You need to ask: Why do I need these tests?" says Lee Hilborne, M.D., an official with the clinical pathology society. Cataract patients, for example, often get an EKG, blood work and a chest X-ray, says William Rich, M.D., of the ophthalmologists group. "They're paying for tests we don't think are necessary," he says. Average costs run $300 to $400.

Danger: Aside from the cost, a few test results come back abnormal even though the patient is fine — causing anxiety and further tests that could delay the surgery.

Exception: A patient with a severe heart condition or symptoms that could be heart-related should have a presurgery EKG.

Diabetic patients need a blood glucose test and those on diuretics should have a potassium test.

2. Recommendation: Don't take prescription sleeping pills as the first choice for insomnia (American Geriatrics Society).

Insomnia is very common in older people, but experts say seniors should avoid some widely prescribed sleeping pills, such as Restril and Ambien. Instead, talk to your doctor about other therapies, such as counseling to improve sleep patterns through lifestyle changes.

Danger: Meds called sedative-hypnotics, including benzodiazepines, double the risk of falls and hip fractures, leading to hospitalization and death in older adults, according to several large studies.

"It's not entirely clear why; it may be there's some carryover the next day," says Cathy Alessi, M.D., president-elect of the American Geriatrics Society.

Exceptions: For seniors, prescription sleeping pills (sedative-hypnotics) should be reserved for anxiety disorders or severe alcohol withdrawal after other therapies have failed.

3. Recommendation: Don't get a screening test for carotid artery disease unless you have symptoms (American Academy of Family Physicians).

Companies provide screenings for carotid artery stenosis — the narrowing of arteries that can lead to strokes — but unless you have symptoms, don't get scanned. "The scientific evidence is very clear that more people are harmed than helped by having this test, and we advise against it," says Glen Stream, M.D., board chair of the family physicians group.

Danger: Screening someone with no symptoms of carotid artery disease could lead to further tests and even surgery, which carries increased risk of stroke.

Exception: If you've had a transient ischemic attack (TIA) or ministroke, you may need a diagnostic test.

4. Recommendation: Talk to your doctor about not having a urinary catheter. If a catheter must be used, have it removed as soon as possible (Society of Hospital Medicine).

One in five hospital patients has a catheter, but about half don't need one. Sometimes they're used for incontinence or the convenience of the patient or health care staff.

"Don't get a catheter put in. But if you have to have one, get it out as quickly as you can," says John Bulger, an official with the society that represents hospital physicians. While patients hate it, wetting the bed or intermittent catheterization is far preferable to the continuous use of a catheter, he adds.

Danger: Urinary tract infections from catheters are more prevalent the longer a catheter is in place. Urinary tract infections are the most common hospital-acquired infection, and can be fatal. About 13,000 people a year die as a result of infections from catheters, a study found.

Exceptions: If you have surgery, you may need a catheter. Guidelines call for its removal the next day.

5. Recommendation: Skip the annual Pap test (American College of Obstetricians and Gynecologists and American Academy of Family Physicians).

If you're under 65, get a screening every three years. After 65, if you've had several normal Pap tests, you can stop having them.

"Pap smears annually are a waste of money," says Gerald F. Joseph, M.D., of the OB/GYN group. "In average-risk women, studies show no advantage to annual screenings over those performed at three-year intervals."

Danger: False positive results cause anxiety for patients.

Exception: If you've had cervical cancer or cervical disease, continue annual Pap smears. Cervical cancer is caused by the Human Papillomavirus (HPV), which is transmitted through sexual relations.

6. Recommendation: Don't use testosterone for erectile dysfunction (American Urological Association).

A number of TV ads and men's clinics are pushing this remedy, but most men should skip testosterone supplements if their testosterone levels are normal.

"Anecdotally, we know a lot of prescriptions are being written for testosterone for men with normal testosterone," says Daniel A. Barocas, M.D., assistant professor of urologic surgery at Vanderbilt University Medical Center. But he says the prescription doesn't work for erectile dysfunction.

Danger: Testosterone does not affect the ability to get an erection. It enhances libido or sex drive but not performance. It also reduces fertility and may make prostate cancer blossom. Prostate cancer thrives on testosterone. Gels can irritate the skin; injections can increase red blood cells.

Exception: If you have other symptoms of low testosterone, including loss of muscle mass and body hair, talk to your doctor to see if hormone testing is right for you.

7. Recommendation: Don’t order a blood test for creatinine or upper-tract imaging for patients with an enlarged prostate (American Urological Association).

Most men after age 50 have enlarged prostates, which result in urination that disturbs sleep and a weaker urine stream.

Danger: Even routine tests are not risk-free. Patients spend time and money and may get false positive readings, leading to other tests. CT scans mean radiation exposure.

Exception: Tell your doctor about blood in the urine, pain with urination or urinary retention.

The full list is available at ChoosingWisely.org.

Topics: doctors visit, medical research, healthcare professionals, urinary tract infections, Medicare

What’s All The Buzz About “B”?

Posted by Mens Liberty

May 25, 2013 9:31:00 AM

B-vitamins have become trendy.  There are B-12 injections to fight anemia and to boost your energy.  There are B-vitamins added to energy drinks.  Another popular form of B-vitamins are sublingual (under your tongue for fast absorption)!  And if you look around, you’ll find them added to or fortifying lots of other foods, drinks and supplements these days! 

So here’s the scoop.  Both B-6 and B-12 vitamins specifically assist in turning food into fuel.  And since your body thrives on energy, people often associate B vitamins with their body’s energy boost.  However truth be known, B-vitamins aren’t really energy in and of themselves at all… 

Nor are they anything like a natural form of caffeine.  I think we all know that caffeine alone can be effective within 15 minutes of consuming it.  And caffeine is really where most “energy boosts” come from. 


Almost all energy drinks that contain vitamin B’s are relying on the caffeine that’s in them to give you a boost.  One of the most popular drinks is Monster, and it has 184 mg of caffeine.  Compare that to a typical cup of coffee – 100 mg of caffeine.  The little 5-hour energy gulps have 215mg of caffeine.  With that much caffeine, they really don’t need the vitamin B element! 

So how did we come up with the association of B’s with energy?  Many years ago, medical doctors and scientists discovered that people suffering from depression had lower than average levels of B-12 and B-6.  Both of these vitamins produce brain chemicals that can affect mood.  And one is hardly peppy when feeling low.  In addition, some digestive disorders lack sufficient B vitamins, and they can block food absorption for energy. 

Here’s the energy flow:  B-6 (pyridoxine) is required for the synthesis of brain neurotransmitters.  The neurotransmitters are a chemical messenger that communicates between neurons and other cells in the body. 

B-6 is associated with serotonin production - that affects our central nervous system and our body’s gastrointestinal (GI) tract.  Serotonin in the GI tract will regulate digestion, hence the absorption of food for fuel.  Serotonin levels are also linked with regulating mood, sleep, appetite, learning and memory – all “motivators” for many of us. 

True B-12 deficiency can occur from unknown reasons, however it isn’t as common as you may think.  Some individuals have “pernicious anemia” as a medical condition.  This is when B-12 is not absorbed in the intestines.  B-12 injections from a healthcare professional typically resolves this issue. 

The best way to make sure you’re getting enough B-6, B-12 and all other essential vitamins and minerals is to eat a healthy balanced diet.  This means lots of fruits, nuts and vegetables, and a reasonable amount of animal protein for B-12.  If you’re a strict vegetarian, you’ll have to look for your B-12s from other sources, such as whey powder, yogurt, and yeast extracts. 

So enjoy your B’s and feel beautiful inside and out. 

 Top 10 Foods Highest in Vitamin B-12: 

1.  Clams, Oysters and Mussels.

2.  Liver from lamb, beef, veal, moose, turkey, duck and goose.

3.  Caviar (fish eggs).

4.  Octopus.

5.  Fish – Mackerel, Herring, Salmon, Tuna, Cod, Trout.

6.  Crab and lobster.

7.  Beef.

8.  Lamb.

9.  Cheese – Swiss, Gjetost, Mozzarella, Parmesan, Feta.

10.  Eggs.

Topics: healthcare professionals

How Can I Get My Medical Records?

Posted by Sarah Woodward

May 23, 2013 9:33:00 AM

For those of you interested in seeing your personal health records, we've been asked to share some basic guidelines. This info is from MedicalRecords.com and outlines how you can access your complete medical records -

Access Your Personal Medical Records

Access to personal medical records is guaranteed under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Under this law, patients may submit a medical records request, and the personal medical records must be provided within 30 days. Though originally designed to provide access to paper medical files, the law applies to accessing electronic medical records (EMR) as well.

Obtaining your personal health record is as simple as making a medical records request from your doctor. The exact procedure for accessing a personal health record differs from state to state, with some requiring a written medical records request and others accepting a verbal request for your patient medical records.

Ways to Access Your Personal Medical Records in Writing
Some advocacy groups recommend that a medical records request be made in writing so you and the health care provider have a record of the transaction. The Privacy Rights Clearinghouse, a pro-privacy group, has put together a sample request for medical records form letter to help you obtain your personal health record.

Release of Personal Health Records: Rights and Fees
Once received, you have the right to review your personal health record (PHR) and seek changes to information you think is wrong. However, if you want a hard copy of your personal medical records, doctors and hospitals may charge a “reasonable fee” to cover time and cost of materials.

You also have the option to send your personal health record directly to healthcare professionals. If you choose to go this route, most doctors say it is good to let them know ahead of time so they can know when to expect them.

Paperless Medical Records vs. Hard Copies
Proponents of transitioning to paperless medical records say that EMR / EHR systems will decrease the costs of maintaining patient medical records, making it faster and cheaper for doctors to gain access to medical records and thus for patients to submit a medical records request.

For doctors transitioning to paperless medical records, the most successful “were characterized by even more benefits and time savings per patient,” concluded a 2003 report compiled by the University of California on small medical practices that adopted EMR or EHR.

Sensitive Information
While most patients have no problem gaining access to medical records, there are times when accessing your personal medical records request may be rejected. These situations include any time when your physician or provider believes releasing the information to you could endanger you or someone else, or when special exemptions are provided under law, such as for mental health records, which are exempted from disclosure requirements.

Still have questions about how to get your files? Let us know!

Topics: proactive patients, healthcare professionals

Toilet Talk: Things You Should Know, But Probably Don't

Posted by Sarah Woodward

May 16, 2013 10:15:00 AM

Tracy Sher pictureWe're thrilled to share a post from Tracy Sher, MPT, CSCS. - Pelvic Physical Therapist, Faculty for Herman and Wallace Pelvic Rehabilitation Institute,  and founder of the awesome Pelvic Guru Blog. She posted this late last year and I recently found it once again and was inspired to share.

She has some great advice that we're keen to share with all of you!

Orange Line


Parents can relate to the fact that we spend a lot of time potty training children. However, that’s likely the only time we experience “toilet talk”.  When I provide basic bowel and bladder tips to my adult patients, I am always surprised when they say “why didn’t anyone tell me that?”.  So, here’s a list of of some of the best tips that every person should know about toilet talk.

  • Don’t force your children to go to the bathroom “just in case” or just out of convenience too often. This presents two challenges: 1. The bladder and nervous system are very sensitive. If your child goes to the toilet without an urge regularly, the bladder will become sensitive to that threshold; and they will feel the urge to go more often. 2. This behavior is easily carried with them into adult years with potentially unnecessary episodes of urinary urge, frequency, and hassle. * There are obviously times when the decision to use the toilet early is advisable.
  • Did you know that the average healthy adult should be able to wait 2-4 hours to urinate? Can you wait that long? The most common thing I hear “but you don’t understand, MY bladder is so small. I have to go every 30 minutes…”. Generally, there are easy ways to train your bladder to wait longer. As indicated in the prior point, you may have had habits for many years that predisposed you to believe your bladder was small and unruly. Remember, don’t go to the bathroom just in case (NO JICs). Your bladder is constantly storing urine. So, if you go early, you will likely urinate, but this does not mean it was time to go yet.
  • Urinate when you wake up in the morning. Your bladder needs to get “flushed” out. The rule of waiting 2-3 hours to urinate does not apply here.
  • Don’t sit on the toilet for greater than 10-15 minutes at a time. This increases risk for hemorrhoids, worsening of pelvic organ prolapse, and more pelvic floor issues! On a related note, NO STRAINING with bowel movements. When you strain, there’s a significant amount of pressure placed on the pelvic floor and surrounding structures. So, sitting for greater than 10-15 minutes + straining = unhappy and unhealthy pelvic floor.
  • Women- remember to always wipe front to back (after urinating or having a bowel movement). This reduces the risk of introducing bacteria and other bad elements into the vagina and urethra.
  • If you feel a bulge or a “golf ball” at/near your vagina or rectum or you need to use your hand to help with bowel movements, you possibly have some form of a pelvic organ prolapse. Other symptoms can include increased urinary or bowel urge, constipation, and a pressure feeling worst with standing up or straining. You can discuss this with your gynecologist, family physician, or pelvic physical therapist. You are NOT alone. This is common, but patients feel very embarrassed to share. But there is help for this.
  • Do you like to wear Spanx, shapewear, girdles, or pantyhose?  They are totally slimming, right? Guess what? They can also impede your pelvic floor muscles from fully relaxing when you urinate or have a bowel movement. When you sit down on the toilet with your slimming designer fashion, make sure to slide them all the way down as close to your ankles as possible. This way you can relax your pelvic floor and allow for best chance of fully emptying your bladder or bowels.
  • Have you ever read a magazine that told you to try to stop your flow of urine to check to see if your pelvic floor muscles are strong? Well, it’s technically one way to check, but it’s not good for you! Some of my patients thought they were supposed to do this every day on the toilet as part of a Kegel exercise program. No, no, no. This can cause all sorts of issues.
  • If you experience bowel or bladder issues- such as constipation, irritable bowel, painful bladder syndrome/interstitial cystitis, urinary urge or frequency- there’s hope!  There’s a high likelihood that you can modify your diet or fluid intake and make significant changes. For example, did you know that caffeine and alcohol can increase urinary urge? I have also seen many cases of constipation drastically improve with proper diet modifications. Take this seriously!
  • As a general rule, adults should not need to get up in the middle of the night to urinate. As we age and get to 60+, urinating one time during the night is normal. Oh, and pregnancy is also an exception. Two easy tips: 1. Limit fluid intake to little or nothing 2 hours before bedtime. 2. If you feel an urge to go in the middle of the night, see if you can fall back asleep and resist that urge to get up. On a safety note, if you do wake up to go to the bathroom in the middle of the night, please make sure you have a well-lit, clear path without furniture, uneven rugs, or toy soldiers in your path.
If you found these tips helpful or want to share more, please leave a comment and sign up to follow us. Pelvic Guru also welcomes and receives great comments and updates on the Facebook page.

Blog post by: Tracy Sher, MPT, CSCS. - Pelvic Physical Therapist, Faculty for Herman and Wallace Pelvic Rehabilitation Institute, Founder of Pelvic Guru, Consultant and National Speaker.
* From www.pelvicguru.com

Topics: doctors visit, healthcare professionals