Our first yoga class was a great success. Special thanks to Holley at Yoga HoM for a fantastic class specifically focused on stress relief. Just what we needed! Here's our class made up of myself, some of the team at BrookeMD and patients from BrookeMD.
Taking an hour out of my busy work day in the middle of the week to be still, quiet, calm and reconnect physically and mentally resulted in a more peaceful spirit this evening - which involved a rushed dinner in order to get to a mandatory meeting at my kids school sprinkled with multiple melt downs by my children:) I remained peaceful - even though my child in the back seat of our car was strangely denying that our other child in the car seat next to her was her brother and was screaming about this with tears rolling down her cheeks. As usual, the meltdown resolved itself but the difference was I was actually calm on the inside, having taken the opportunity to reconnect with myself and allow my autonomic nervous system a time of relaxation before adding more stress to the day.
Anyone can do this yoga and feel the benefits both physically and mentally that practicing yoga can bring. Any age, any body type, even if you have no prior yoga experience. Will you join us? Next class is the 3rd Tuesday of October!
If you've been in the office in the past year you've seen a lot of different faces. I want to use this post to introduce you to the fabulous team of Medical Assistants working on the BrookeMD team now. Meet Meghan, Keara, Nicole and Brittney. You will see all four of these smiling faces at different times as you come in and out of the office. Don't be alarmed - we're not having that much turnover! But, I have implemented a new way of rotating job duties within our office rather than the traditional way tasks are divided between employees in a medical office. Instead of training 1 individual to work on the phones, 1 at the front desk, 1 clinical nurse to work in the back of the clinic, etc... we've found it works much better for us and our patients to use medical assistants for all of these roles and rotate them from week to week. So each of my MAs are now trained to work in the front of the office (scheduling appointments, answering phones, working the front reception desk) and the clinical area of the office (guiding you to your rooms, taking vital signs, performing tests, giving injections) and assisting with refills and referrals. It's many different roles that these ladies have been trained in and are performing with expertise. But, I have noticed that it seems to be throwing some of our guests off when they come week to week and see someone different sitting at the front reception desk to greet them or call them back to their room. Hopefully this helps explain why. And you will see the advantage when you call or enter our office now and you are greeted by a fantastic Medical Assistant that can assist you with whatever you might need help with that day. We will take care of it for you!
Last week I launched Project Revive for myself, staff and patients. You can read about it here. The vision for Project Revive began many months ago while questioning if staying in the medical business was going to work for my husband and I who were struggling to match how we were spending our time with our true life priorities.
Just today, I read a quote from John Kim, CEO of GaN in Huntsville, AL and recent award winner of the Russell G Brown Executive Leadership Award from the Huntsville Chamber of Commerce. He said "Define success not in monetary measures but in quality of life, for you, your employees and your community. Once you realize that what matters is the quality of life and not the monetary means, your business will make more sense and you will enjoy life more. The only failure in life is not going for it. Go, do great things, and enjoy the experience of the business. Embrace it as life's opportunity and do it with passion."
This is exactly what Project Revive is all about - restoring a balance of life to not only myself and family but also extending that to my staff, making BrookeMD a place where physical, emotional and spiritual health is fostered. And thus, extending that culture to our patients as well. One component of Project Revive that we have implemented immediately is a daily prayer with my morning meeting with the staff to start our day. It's a simple addition to our morning routine that sets our minds on the task at hand, reminds us of the true Healer and our job to show His compassion to our community of patients. We seek wisdom in taking care of all of you. We seek a spirit of respect towards our coworkers and guests. We are reviving ourselves to our true purpose one small step at a time and using Project Revive as our platform to intentionally commit to making that happen. Join us! I'll keep you updated as more events that are described here unfold.
It’s been almost 3 years since I last posted on my blog. Three years ago, I became a partner at Gleneagles Family Medicine. Shortly after, our senior partner retired leaving Dr. Carter and I as co-partners. I found out Dr. Howard was leaving 1 week before I delivered my 2nd child, Jackson and 1 month before we launched our new optional Concierge program for a small subset of our patients. I’ve taken half of Dr. Howard’s patients into my practice which is now 2500 patients in size and receive applications daily for new patients desiring to join. In the past 3 years, we have replaced all but 2 of our past employees meaning I have reviewed over 600 resumes, conducted many interviews and trained 8 new Medical Assistants. We have hired 3 new Nurse Practitioners. We have remodeled the office allowing for more patient rooms and an updated front lobby. All of this while continuing to care for about 5500 patients within our office. And care for them well – we’re now part of the NCQA Diabetes Recognition Program for example. Personally, my husband and I moved to our new house about 3 years ago. We have devoted our “non-work” time to Claire who is now 4 and Jackson, now 2. I have outsourced every imaginable house-work task. I recently exercised for the first real time since Jackson was born and my calves are still angry with me. Blogging just hasn’t made it to the top of my action items in Evernote. But, at the office we now have a fantastic staff and recently, divided the staff for each doctor to have their own dedicated team. My practice is now BrookeMD at Gleneagles Family Medicine and BrookeMD is on a path to transformation!
I love what I do. It is a beautiful service to provide care to patients in the unique relationship developed between all of my patients and myself. I love to do what I do well, exceptionally in fact. This places me in a tough situation given the horrendous mess our health care system is in now. I could write the rest of this blog on my own daily challenges within our health care system. Given how depressing that would be, I have decided to dedicate this blog with 2 purposes in mind.
Malcolm Gladwell was recently interviewed by Eric Topol, MD on Medscape. He notes how poor of a job the medical profession has done at telling their story of healthcare. I agree there is a huge disconnect between what my patients seem to think I do as a doctor and what I am actually doing. In a profession where patient confidentiality is a sacred rule, the story of our profession, our struggles our triumphs and our day to day lives have been lost-except when misrepresented by fictional characters on tv shows. My first purpose is to simply share more of the story of BrookeMD with my patients. I’d like for you to have more of an understanding of why we have changed your flow through the office, why you are asked to complete paperwork periodically, why we are implementing the Medicare Chronic Care Management Program or why I use Nurse Practitioners. This blog won’t be for everyone, but it is for you, my patients, to bridge the gap of understanding to explain why we are doing what we do in your medical home.
The 2nd purpose is to allow you to come with me on my BrookeMD Transformation. I see daily the results of people living their lives devoted to their jobs, slaves to their material possessions, connected completely to their digital devices all while their physical, mental, emotional and spiritual health are neglected to the point of severe medical conditions. People in America are exhausted. We can’t seem to let go of the escapism of our technology and the search for more power and money. It is a hopeless feeling to treat a person for their uncontrolled diabetes by adding more medication that they cannot afford but believe that their insurance company should pay for anyway all while they continue to not make lifestyle changes to control their diabetes themselves. I will burn out if that’s really what I am spending my medical profession doing because it doesn’t work, it’s hopeless. The health in our country is evidence to that. So I am transforming myself personally and professionally to not get sucked in to the health care system as it is, to make BrookeMD a place where myself and my employees can live healthy balanced lives while providing service to our patients and to provide for you all what you really need to improve your health and your lives. This is true reformation of healthcare in my small microcosm of BrookeMD. Stay tuned and we will transform our health and your medical home together.
So far this flu season for our Region (AL, FL, GA, KY, MS, NC, SC and TN), incidence of flu remains below the national average for this time in the season. However, our numbers are increasing. There have been 226 reported cases of proven flu to the CDC. 1 of those resulted in a pediatric death. 6 of those cases were the H1N1 strain from 2009. It’s important to protect yourself before you are exposed to the virus. Come get your flu shot! To read more about the safety of this year’s flu shots, click here.
Choosing Wisely is a new campaign designed to help patients and physicians understand when certain tests need to be done and when they don’t. Nine different speciality societies (including the American Academy of Family Physicians) have been looking at evidence and providing resources published to the public through Consumer Reports. You can access these resources online at http://choosingwisely.org/?page_id=13.
The campaign has published lists of specific tests for medical problems that are often ordered but frequently are not needed. For example, one of the most common reasons I see patients in my office is for back pain. While back pain can be extremely painful, most often acute back pain resolves on it’s own in 6 weeks. However, many patients end up getting imaging tests done such as X-rays or MRI’s during that first 6 weeks. In our American medical culture, we often have the perception that more information will help you get better faster. But, that is not always the case. In fact, imaging of the back in patients within the first 6 weeks of back pain does not improve the outcome for the patient and often leads them to have procedures done which likely they did not need. In fact, I see many patients who have even more back pain after surgery which likely did not need to be done in the first place. Thus, the AAFP has recommended in their Choosing Wisely list to avoid imaging for patients with back pain within the first 6 weeks of the onset of their pain.
I agree with this recommendation. The problem is that many patients do not. And in an effort to satisfy the patient, doctors end up ordering the tests anyway. Also, in our litigious society, doctors are afraid if they wait to order the tests and it turns out a patient does need a further procedure, they will be sued for delaying the diagnosis (despite the fact that studies show it does not affect patient outcomes.)
These lists are an effort to encourage patients and doctors to discuss when tests are actually needed. And, I encourage my patients to recognize that more tests are not always the answer for your discomfort. Ordering more tests is a large part of the reason that America has the highest cost of medical care and the most unhealthy patients.
One of the most common complaints I hear from patients is that they are feeling worn down and tired. They feel they just don’t have the energy they used to have. This can be a symptom of many medical diseases that need to be checked out by your doctor. However, if those are checked and everything comes back normal, there are other things you can do to get that energy back!
Let’s take a look at the average American lifestyle for a moment…it can be summed up in four words: sedentary, poor diet and stressed. Do you see that in your own life? How do we expect our bodies to function properly when we fill them with unhealthy foods and become so sedentary that even a walk through the grocery store can be difficult . And, when our minds are racing constantly with thoughts related to stress in our lives (“I need to get up earlier to get more done” “My house is a disaster” “My job is taking up too much of my time” “My family is driving me crazy!”) it puts stress on our bodies as well. Our minds never slow down and just rest. If our minds are not rejuvenated daily, our body will not be either, especially if it’s already struggling to overcome the fuel we are feeding it.
You cannot expect your body to feel energized unless you are caring for it properly. It may hang in there for a while, but eventually it will catch up to you and you will begin to feel worn down. I notice that for many people who feel that way, it’s because they ARE worn down. Give your body a break and stop expecting it to function at 100% when you’re only giving it 1%.
Get active, cut the trash out of your diet and find a way to de-clutter your mind. Your body will thank you for it.
A recent article in JAMA reviews an updated report from a trial called the SELECT trial looking at the effects of Vitamin E on prostate cancer. The study began in 2001 looking at the effects of prostate cancer in three groups of men: men taking just Vitamin E, Vitamin E plus Selenium and just Selenium. The results published in 2008 revealed there was no decrease in the number of men who developed prostate cancer in any of the three groups. In fact, there was a trend toward an increase in the number of people who developed prostate cancer. This was studied further over the past three years and now the results are out…there is a 17% increase in the incidence of prostate cancer in men taking Vitamin E (400 IU per day).
Just a reminder that just because something is “natural” or over the counter does not mean it is without the risk of side effects. Make sure your doctor knows what supplements and over the counter medications you are taking.
Psychoactive Bath Salts (PABS) are becoming one of the more frequent drugs that Emergency Departments are seeing patients abuse and lead to overdose. Bath Salts go by names like Zoom 2, Aura, Vanilla Sky, Ivory Wave and White Rush and can be found in gas stations, truck stops and on the internet. The DEA has now banned these drugs as of Sept 7, 2011 and moved to make these a controlled substance in the US. In fact, the DEA used its emergency scheduling authority to temporarily control the substances in bath salts, giving them a year to decide with the US Department of Health and Human Services if it should be permanently made illegal.
PABS are made with a main ingredient called methylenedioxypyrovalerone which gives them their stimulant effect. (This ingredient is not found in aromatherapy bath salts used for bathing.) These drugs are abused by taking them orally, intranasally, intravenously or rectally. PABS are a stimulant and give a high similar to meth, causing symptoms such as paranoia, hallucinations, psychosis and delusions. Overdose can lead to renal failure or death.
Most studies suggest that an average of 8 hours of quality sleep per night is what people typically require to maintain their mental and physical health. Not getting quality sleep in the right quantity for your body can have detrimental side effects on your well being. Some of these include decreased cognitive function, depression or anxiety, low energy, decreased libido, poor judgement, increased risk of dying (especially from motor vehicle crashes or work place accidents), increased blood pressure and heart disease, decreased immune function and increased appetite! Our sleep is important to rejuvenate our bodies so that they can work properly for us. Here’s a quick test to see if you have excessive daytime sleepiness which may be related to poor sleep quality at night.
How likely are you to doze off or fall asleep in the following situations? Use the following scale to answer the questions then add up your score at the end.
0= would never doze 1= slight change of dozing 2= moderate chance of dozing 3=high change of dozing
1. Sitting and reading
2. Watching television
3. Sitting inactive in a public place ( a theater or meeting)
4. As a passenger in the car for an hour without a break
5. lying down to rest in the afternoon
6. Sitting and talking to someone
7. Sitting quietly after lunch
8. In a car, while stopped in traffic
If you score a 10 or greater, check with your doctor for an evaluation. You may have a sleep disorder preventing your body from getting the good quality sleep it needs, not to mention making you cranky and overweight!
Brooke Uptagrafft, MD
Dr. Brooke is a family medicine doctor.