Establishing a Health Baseline with Your Physician

I will be honest this is not a talk I’ve ever
given before. It’s kind of a unique topic that people don’t often think of. I’m often asked to talk about specific disease processes the about you
know concern to the elderly since I am a
geriatrician by training but this is an important topic for
patients of all ages so I’m grateful for the opportunity to
talk about it more welcome your questions at the end so getting started so the title of my talk
is establishing a health baseline the who what when where why and how connecting to the medical world can be a
daunting task in knowing where to start is an important way to kinda set yourself on a path toward
achieving your health care goals so the case for baseline from maine plainly
biased point of view I am a primary care provider by training
and so you know I firmly believe in the outs of
prevention method approaching health care and so you’ll need to take what I say with a
grain of salt since think that is my my wheelhouse so to speak but I think
it’s important to kinda look at why is this even important so who needs to establish a baseline with
with the health care provider the short answer is almost everyone if you have a medical illnesses that may
be more pertinent than than a few your seemingly healthy but as I go
through here briefly I think the population of people that
really need to create a form a baseline with a provider is is broader than you
may initially think so what exactly is a baseline I’m its very similar to
what you would think about it’s not like it’s a formal term that we we throw out all the time but it more a
general concept it it’s essentially where you as an
individual or act on the broader spectrum love your
overall health and that’s not just physical health but
also your mental health and emotional health and where you are and so I use this I’m diagram kinda it I subway map and it says you are here and
it’s just meant to illustrate that there are many me lines that that I you need to
navigate as part of your overall health
perspective and you know establishing care with the
provider can help you do that on so thankful your baseline ok you want to
break it down into kinda more definitive components you your health is your existing lol as
well as your risk for feature LS and seeing you know you may
not have much existing LS but preparing for the future
can be came even important part maintaining
good health I the goal was really for this to be a
starting point for you to kinda make some plans and decide what
actions you need to take now for your future health care so the next
question which I’ve heard from my husband time
and again is why do I need to establish a health-based line people generally don’t like to go to the
doctor or the nurse practitioner PA or whoever you
seek for your your health care I’m can be time consuming it can be
spent there that can be just difficult to work into your your
daily schedule I’m busy life on you may think I’m healthy I take no
medication why do I need to go see somebody and
that the short answer is because you may not stay healthy because although you may not have illness now
you may need to do things now to prevent illness down the route so there are
basically two components to good health so there’s the appropriate treatment of
current LS which is what everyone classically think that
we have positions do. but there’s also appropriate prevention to help prevent further illness down the
road and that’s really where establishing a
baseline can help improve your outcomes and I and improve
your life down the road as well specific things we look to rent would be hospitalization you know Stanford
Hospital the wonderful place but if you can avoid hospital in any case you’ll be better off for it
in the long run I medication what a complaint has
brought us many amazing you know drugs that can do wonderful
things but if you can avoid having to take anything as a geriatrician i’ve seen your you’re
better in the long run and finally procedures and
surgeries although we can do amazing things with
hip replacement and you know abdominal surgeries and
things like that you can avoid needing to have these things if it’s always better to avoid that
kinda rest by you know I medicine and science we like
to see me things from kinda a data-driven
perspective so is there any evidence to show that it’s worthwhile for people the kind of
established your general health care baseline so start with the negative evidence on this is by no means a comprehensive
review of all the literature on preventative care but it’s just kind of kind of an
overview to give you some idea up why there may be mixed views among
different I’m differ experts as to whether it’s
really worth while to establish with the primary care doctor so I one good source I found was a
meta-analysis it consisted of 14 randomized controlled trials which are consider act like when you’re reviewing:
medical literature it what data 180 2,880 at all so things the general health checks do not
do you they do not decrease morbidity or mortality related to cardiovascular
disease which is the number one cause of death in the United
States at close to 600,000 deaths per year and it
doesn’t decrease morbidity or mortality from from cancer either which is close behind
is the fact that cause a death in the United States they
also do not create changes in the IRA to cardiovascular disease rates have cerebral vascular disease or
stroke TIAA zookeeper things like that or rate the cancer and from a strictly
business standpoint there’s no change in the rate of those
costly hospital admissions in the number referral to specialist or
in the number of work out for so not a great case I’m making so far the one thing that was proven to be changed by you know having people get these general
health exams you do increase the overall number diagnosed that you
can two people which is true we’ve you go to see a doctor or I
whatever primary care provider you see chances are you’re going to walk out
with a diagnosis or two you didn’t happen you walked in but it’s not all doom and gloom
primary-care not going out of business anytime soon
because there are still many good reasons and good scientific evidence behind it
so first start by looking at kinda limitation love
these negative study is that we’ve had that just paying this terrible picture above
kinda doing this preventative help pay check so I’m a
trial that I reference therein that matter now office their order trials done anywhere from
1963 to 1999 they really don’t account for potential
benefits of newer advancements in treatment that we have for instance
screening test something like that we have come a long way over the decade think 1963 and what we can do
to help improve people’s care and the study
simply don’t take that into account the setting for the exams for many of
the studies it wasn’t that they went into doctor
Jones office down the road and looked at patients and saw how they turned out it was they collected subject they I’m put them through a routine screening
with the person they had never met perform any sort of relationship with
who probably had limited information regarding our past
medical history family history social history at that are and they look at the basic scientific
outcome very different than the general scenario
and a primary care providers office and then
there’s the the usual reason by call them for why
trials are bad sample sizes by yes statistical analyses not be an
ideal all the usual reasons we call into
question many others data that we are so driven to to look at closely survey said in a survey done by the American Academy
of Family Practice again a little biased sixty-six percent
of patients prefer to have an indiv at annual physical exam and I I have that happen all the time in my
practice why have patients come in not say what can I do to help you what
your you know what can I help you with today you have a complaint concerning what can
I do for you and they said I’m just here for my
annual checkup and it’s not often that happens but when
it does it it really drives home this idea that
people just want to make sure our things are okay and this somehow we have
in our head that 12 years the time to do it may be a part
that comes from insurance is encouraging you to get your annual exam that are a
terabyte I’m people do like the idea of having
your any of this I’ll another systematic
review looked at 21 study can have them were
those good old randomized controlled trial and their
conclusions were that there are more I’m multiple
positive effect on patients specifically who underwent recommended
screening such as pap smears cholesterol
applebee’s fecal occult blood depending if your doctor’s a ver had to do that so testing their the stall for Blyth
doesn’t mean the affecting your risk for colon cancer on and you know these preventive screenings
that are proven by very good data that AP New do them across the population it can
decrease your rates are things we worry about like cancer like heart disease like stroke and for what it’s worth a pound a decrease
in patient worry people just felt better when they had their check in with their
primary care provider and felt like they had a good assessment how
they were doing from a health standpoint another study in this was published in
the International Journal of health services found that states with more primary care
providers per capita have lower rate the cardiovascular
disease rate the cerebral vascular events and
rate the cancer you may remember that lester same things
that I put I’m from the maze studies that you know general health checks were not proving
to do so whether you can make the link between
just there being more primary care providers and better overall health outcomes again at
the matter if it’s just going to predation but it is a something that was was
observed and probably have some merit to consider and
then yet another study found that having primary care provider is
associated with a longer life span again not the randomized controlled
study not necessarily the most rigorous scientific method used for this but in general can help in some studies to to improve your life
span no looking at all that beta general check
seem to have more about thumbs-up approach as the truth is in
many scientific issues they answer is probably somewhere in the middle who probably don’t know these are very
difficult studies to do and there’s notta lotta financial
incentive to to be driving me things but I think
health systems in general are looking more towards proactive approach
to help as opposed to a reactive approach and so I think we’re going to see more
MORE this data coming out about is it worthwhile to kind of
engaging in more preventive health care I think a lot of the right now it’s
coming out at the UK because with their I’m single-payer system they need to
know is it worthwhile for us to screen you know the entire population a the health system is that is that a
financially reasonable thing to do so what do you do up well next going to give you some reason a how a health baseline can really help your show tangible
outcomes for you not just don’t feel better maybe you’ll live longer maybe
I’ll have a less risk of a heart attack but what can I do for you so who knows who
these ladies are we have mary tyler moore who is one of
my all-time favorite people Halle Berry a starlet herself anybody
know what they have in common they both have diabetes very good so they both have very similar stories
to where I mean they are not the typical
picture diabetes on they are being it young women who were diagnosed with
diabetes at a very young age I think I’m you holly berry story is
much more dramatic where she was feeling pity you know the phone
she whether this column I know what knew it was wrong with Turner turned out to
be with the diabetic Mary Tyler Moore has a much more
reasonable story which was she would be the acting and she just
wasn’t feeling quite right and she went into the hospital for
another unrelated procedure and they found her blood sugar with over
700 which normally our blood sugars run in the 100 200 300 range even after
eating so really high blood sugar and that’s how
she found out she was a diabetic we either way it an ideal way to find
out that you have a debilitating disease like diabetes but although I caught the donating it
also very treatable and it’s something that can be very
well-managed if you have a good relationship with your provider that is
managing this disease for you up and diabetes aside it more broad general health issues you
know i i the goal to help baseline would be to
help you you know prioritize what are your actual
issues that you like a draft goals that you like to achieve and what’s going to be an effective
intervention for doing that you know what say that your goal is you know I just I wanna lose some weight
I put on some weight you know in in my 30 after I had my babies and I just
would like to lose some weight and you know rather than just doing
another bad diet or yo-yoing and starving yourself and then ending up
just bingeing on sweep later you’re talking to a primary care
provider can help find a more reasonable approach to me your health care goal up so when should you have this done how
often do you need to see a doctor how often do you need to have a regular
follow-up as the answer so often is in Madison it did and if you have multiple chronic
issues that need to be managed if you have you know everything illness
recent surgery you may be seeing your your primary care provider on a more
regular basis you may also need anything other
providers however if you’re 25 years old you have no real medical
history of a lower risk factors and you just are out of that window where
you know we start our lives being dragged to the doctor’s office by our
parents because we need our immunization they check our way in our height know it was good thing and
then as we move into high school we have a mandatory school physicals sports
physicals at that are up and in college or we know whatever your
post high school life is you are just busy and young think you’re
invincible and don’t care and then somewhere along the way you get
a job in your your job makes you get a physical or you just kinder fall off
the radar are the medical world and many people think that radar for decades
I’m tell something happened and why I’m hoping to you know get across to today as may not
be the most efficient or effective means a really taking control of your health and
and preventing long-term outcomes so think the answer is it depends but the
most important thing to know is that there are recommended routine preventive services
like mammogram like pap smears like colon
cancer screening that need to be done regardless a how frequently you see your primary care
provider and so staying in touch with them having
someone that that is you know keeping tabs on you so
to speak can help make sure that these things do get done because regardless of whatever date I’ve
shown you so far there’s Act one day a that these type of preventive
intervention do make a difference and people’s long-term morbidity mortality
so gonna say well I commend you all that
you should go see a primary care doctor and so the next
thing i’d like to talk about in kind of switch gears a little bit do
with talk about what what is that first visit going to look
like whether it’s you now you haven’t been to the doctor
and fifteen years and you don’t even know where to start or at
you move to a new area or you just switched you know switch providers what can help
you get off to a good start as you’re trying to establish this health care
baseline especially if you feel like you’re
healthy you take no medicines where it would you even say it use gonna awkwardly sit there in silence
and wonder if they’re gonna make you put it down on an you know hope that they don’t you know
give you a shot today or are you gonna take some proactive steps to make it a useful
visit for you and for your provider so step one the most important find the right person
for you can make a huge difference on how you
view the medical system to your help and how much how you interact with that
down the road if you find the right person so the first what I said is is provider so there’s a million doctors out there
you can see some patients I have a they just follow the cardiologists has
become like their primary care doctor over there over the decades and that too they trust and they came to my
office manager actress department because they were in the hospital on the
discharge planner for them to me or their daughter thought they needed someone
else when they dragged him into the office you know there’s there’s a lotta reasons
but you know if your you know if your obviously your child on
a pediatrician or family doctor may be a better option for you if you’re kind of in that middle age
range menu think maybe a family doctor maybe an
internist and then as you get older maybe you’ve
had your same internet for 20-30 years in your perfectly happy and a person not retiring anytime soon so
you’re OK to stick with them or maybe you worry that your health is
getting more complex than that who are concerned about the issues that
go along with I’m with growing older and so maybe a
geriatrician may be a better option for you finally some you know some women in
their childbearing age in their obstetrician-gynecologist end up
serving as their primary care doctor whatever me provider you choose its it’s important that you off feel
comfortable with them and that you up you are willing to kinda establish a long-term relationship
with them I’m so that you have that continuity of someone who know with you number two is an important
one we see all the time it insurance
coverage so you may think that you found the experts in the best person in the
world but if they don’t take your insurance whatever that may be it can end up being a very expensive
endeavor so I think most offices are you know their
intake corner coordinators are trained to to check
with you and talk with you about you know what financial expenses may be incurred on in
establishing a baseline but it’s something important to consider
as you’re looking out to establish care with someone and finally it’s personal preference so
how do you find that person that you’re gonna trust in spill your health got to you and feel
like you can talk to you and ask questions too and is really going to do
a good job 30 on what I angelito your friends and
family is ask your neighbor you know ask your friend ask someone who you feel
with similar to you who is your primary care doctor you know
who you know that got her who do you like or you know if you have that cardiologists
you know and trust like can you recommend someone to me on its it’s a great way to start you know I there just like patience providers have a wide array of
personalities and and finding the right that can be an
important in you being willing to to stay with the same
person rather than kind of jumping around and you know
trying to trying to find someone that that maybe fifty maybe job do your homework it’s my next take on
point so if you’re willing to put some work in
before you show up at the doctors office your probably going to get a lot more
out of your point so the first thing I out we say as is their previous questionnaire for you
to fill out now many times if you show up hander issued a paper on a
clipboard with a bunch of things for you to sign in and ask you to fill stuff out
and there you are on the spot trying to remember anyone in your family
had heart disease and you know when was the last time that
I you know saw my other doctors or what
was what that does a medication that I’m on and you’re trying to go off without
on-the-spot or they may not even handed to you and your
your left to try to discuss all this with your doctor on during the visit itself which is
often a fairly short time to begin with if you when you’re making
your appointment it you can ask do you does your office
have a previous the questionnaire that you could send me that I could complete
ahead of time or is there going to be one that I i will be filling out what information
should I have for that and whoever is speaking to the schedule the appointment
will be able to tell you that kind of information outside records have you been seeing
another doctor have you been hospitalized recently have
any emergency room lately you are all important things for your
physician or other provider to know I’m in order to be able to accurately
take care of you on and having copies of those accurate that
can really act but I your care a course we can
always request records you know but that ends up being a very
lengthy inefficient process they are can never
happen I than most to my day requesting records
and I think I get maybe thirty percent of them back and then it’s often instead of I I need
your most recent labs I get a stacked with tall with note that note to note the note the
stuff and then important information gets boss just because it’s it’s not the
information we need so trying to get outside records ahead
of time can really help expedite your first bet immunizations every good primary care
provider will ask you about whether you had all your vaccine so your flu shot your your name on your
shot you are a tetanus shot these are important things that you’re
going to need to know and if you haven’t there are things that you could have
done it that busy rather than worry about the finding out you need them later having a comeback separate that knowing
your meditation had a time can be helpful as I mentioned heavy band ED emergency
department have you been to you know stay for the
emergency department to express care or two see any
specialist recently having that information ahead of time
with you well certainly help speed things along on have you seen other physicians in the
past I’m here Stamper we do have the care
everywhere and application built into our electronic
records so if you are seeing it anyone that any of the other health care systems
that we arm in collaboration with such as power
to Medical Foundation on UCF ap then there is some ability for us interface and
pull up records that you have there and they can do the same with I will think there’s a limit to that
though number why we need your permission number two what there is not always what
we needed and number three out of context that
doesn’t make a whole lot of sense so you being aware of those records and
ready to discuss them with your provider can make a huge
difference in in the efficiency and effectiveness of your visit on and finally family history I find that
when the people struggle with a lot and yet it’s one that’s so important because a lot of what we talk about in
in preventive care and health baseline is for many things from happening that you
are at risk for and so much of your rest comes from you
know your genetic you know dispositions that you have and you know you may try to be thinking back didn’t grandma have each offered
relation or why did she have that pacemaker or did I have putting the died suddenly you
know at a young age you know these are things that do make a
difference in terms of what we think is is risk for you and so having that in
your head when you show up it helpful the caveat I
will say is when I asked someone any medical problems running your
history I often get well my grandma sister hair had you know diabetes or things like
that as relevant as my mother had diabetes
and my sister has diabetes so first-degree relatives cell mom and
dad siblings any children you have are really where you wanna start when
you’re telling your provider about what types of issues running your
family next is arrive early in this is especially true here at
stanford so you know we live in the Bay Area where
traffic is a constant battle and and parking and not much better and you know there’s a lot of a wonderful
construction going on for and the new hospital for new facilities and just general road repair but all
these can really delay I your rival unexpectedly and your the time you have a so precious
and they’re so much to fit in especially at that first base line that that you want to
make sure you’re there on time I know we have the issue that humorous outside the brand new neural
science building that’s going up it’s going to be gorgeous if you look on
the website thing the plans for it right now what it does is take up our
handicap parking at least a lot of it and as a
geriatrician that’s a huge issue and so you know it it’s very
difficult it’s something you can park in the
garage to quite a hike to get from the garage and
were up on the fourth floor and if you haven’t you no difficulty
getting around back can be quite a journey 30 and tell
what that time n is is not something most people think
about so think about getting there early but even
if you are on time you may still end up waiting at a constant complaint %uh most
patients is I waited an hour and a half to see this
person and they gave me fifteen-minute that’s
all I got at at at the Rec that is certainly a risk I would say at least in the primary care
world are our goal is to get as much done for
you as we possibly can we recognize your time is precious our time is also precious I say E especially the traditionally also we
often take longer than we think it should with you know let’s say the first
patient today but we really do do our best to 4 15 minutes late getting in to
see you it’s because we took our time were very
thorough about last patient and we will paid up forward to you and although it
may end up pushing everyone back in making everyone behind hopefully be able to catch up at some
point but the goal would be that if we robbed you were fifteen minutes your
time on the front and if your visit will be able to make it up on the back
and a bit and make sure that you gotten to say everything you need if
they discussed everything we need to discuss and you know it the very least apologize
for the inconvenience for being late emergency happened things come up I
think many people think that you know positions are just sitting back
at their desks drinking coffee and reading the news and that’s why we’re behind and
I I will say that that is certainly not not the case on come prepared so this is my general West so one thing I
was recommended a pen and paper because we say a lot of things I know I
write things down all the time during a visit and important you do the same because
inevitably someone was going to ask you so what the doctor say and you’re gonna
think back and it was also clear just five minutes
ago at all if I can you remember nothing and
how many do you have tried to call your doctor’s office after your appointment and try to get to talk to someone and
figure out what they said can be quite a challenge maybe all
reached keep you know when you call our office a lot
of times you’ll get our centralized call center here Stanford their very well-trained and
they are you know very good at their jobs but
they’re not their personal just are you who can answer quickly and say oh I
could pick to win those pills with that i won and so it it can create a lot of extra
leg work on your part take a pen and paper write things down
night can be helpful not just writing down what your provider tell you but also questions that may come up as
your provider talking to you that you can remember that later and try to have a list of questions and
concerns have time because that will help drive the visit to you getting the answers you need many
times people come in with a list of 20 things that I’ll say let give me your top three and we’ll
get there though today and I promise we’ll get the rest
when we can so having those things in mind can help
make sure that you get your questions answered in your most
pressing issues addressed bring pill bottles if you are on
medications there is no substitute for having the actual bottle with the
doses with the pharmacy you feel that and with
how many pills you actually have left for some I patient that’s almost a trash
bag blue pill but it worthwhile in terms of accuracy and medication they’re not something to
be taken lightly they are a chemical substance that can affect her
body in it intake and incorrectly can have major detrimental effect so
having your physician or other provider having an accurate picture of what
you’re taking and how it’s going is really important
Saulo can be a pain and although it may mess up your pill
box system or whatever you with try to bring your actual bottle in
addition to your list to medications with you how I would say bring a calendar because
inevitably you’re going to have to schedule something whether it’s a test or a lab or a
follow-up appointment have your calendar with you so that you can get that on the books
and it’s not something that’s gonna fall by the wayside all the time you’re
it six months later and you were supposed to follow up in three months so
bring your calendar with you it can be worthwhile to check ahead of
time if you need to be fasting at day your
doctor may be ordering labs and although with new technology there’s
rarely a time when you need to fast but in some circumstances you do no stupid things I recommend getting an
early appointment because you don’t wanna show up passing to a2 o’clock
appointment and then have your doctor be behind by forty minutes and you’re
starting on and be here that’s I with a bring a
snack at my general motto in life is bring a
snack because you just never know what’s gonna happen and I don’t know about the rest to view
but I don’t get more impatient or angry then when I haven’t eaten in awhile and
and it can be a while it can be and never-ending journey when
you are have a doctors appointment for the day but it’s worthwhile and one happy I
wanna add is when you talk tell your provider what I’m taking it’s
not just what they prescribe you do you take things like Tylenol advil
other over the counters any by the minute he may take any
supplements you take especially not only is important just
for the actor see what you’re taking in but sometimes the things can interact with other medications
you’re taking things like advil at the geriatrician I hate advil it can be very dangerous for the kidney
it can cause bleeding offer can do terrible terrible things to
older people and so I I just happened last week where someone
happened to mention you know I was looking at their kidney function and it
seemed like it was kind of creeping up and like oh I take an Advil to help me
sleep sometimes and you think you’re off handedly i buy it
at Walgreens it’s on the shelf I can buy it but they can have major back so wedding know
your provider know exactly what you take
critical for their decision-making process so what do you expect anybody know where
that is we need out now be found in the room doctor Clarkson I love him anyway I’m he’s definitely the old-school position who goes the extra mile for his
patients and and excellent role model for for print providers everywhere but but
so what do you expect when you get there we talked about the traffic in the
construction in the way send you know everything that might
happen I’m be the you may need to have lab work
done so have blood drawn and evaluated I’m sorry but it’s just
routine screening like as we mentioned earlier having your
cluster all about you waited on but there may be needles involved some people are fairly squeamish about
me all I’m but it it an important thing to do if it ordered here Stamper we have the
luxury if you for instance are seeing anyone in
internal medicine family medicine or geriatrics here in this building blabbing on the first floor so I can
tell my patients go to the elevator get off on the first floor turn left and
right there our lab else to make things very easy in terms
of getting results back to me quickly in allowing me to discuss what the results mean with
patients on some time with a little more of a hike
to get to the lab by just keep in mind that you may be asked
to do labs right away or to plan to have them done in the
future again with that calendar company I we need any study this is that an important point that I would like to drive home is that your
you may have X-rays ordered or you know a cat scan or
MRI or various different imaging or other
procedures that your provider may order for you
everyone is different in terms of how we get scheduled but
they I order an x-ray your chest if you come to my
office you can still come right down stairs and get that but if I or an MRI that’s a different
process sometimes you call them sometimes they call you and kinda
knowing it would just take them how is this gonna happen are important thing to ask your provider
because you may be sitting around for weeks waiting for the MRI department to
call you in schedule this procedure and it may not happen and if that
doesn’t happen then it’s important to check back with
your provider on where they supposed to call me did I
miss the memo that I’m calling them what the number for them et cetera and and there you have delayed
care delayed evaluation and you know possibly
delaying treatment so if you’re if something is ordered try
to be very specific in asking should I expect a call maybe tell your
provider what number should they be calling for some of my older patients
that are hard of hearing and you know may not
have the the memory to be able to schedule things
themselves I may put in their referral please contact daughter and put her name
and contact information in when I placed the referral so how
many information ready to go and thought about when when things are
ordered can be very helpful also you may need shocked everyone’s you know from from the time you’re young you you
dread immunizations and and there again the New York can be a
fear I but they’re also one of the most important things that you can do not
just to protect urself but to protect others I often have
patience tell me you know the geriatric world I’ve never
had a flu shot I don’t need a flu shot I’m fine and then I say you grandchildren argue great-grandchildren
our little baby is that could you know can become very ill and
hospitalized because they get the flu you may not be made feel fine but your
you can still pass that onto others that may be more rest so when you think about and think never had a flu shot are never had some
other vaccine wash I get it now not just about you it’s about the risk
of those around you as well I’m get a carryall added often helps to
wear shortly to your doctor’s appointment because you
need to get your arm what’s in your heart longs so I’m try to
dress appropriately when you go and finally were for all I’m we have excellent some other world top specialty
providers here at stanford and the question is should you see them there’s there are are doctors I N providers for just about every
specific problem you could possibly think I’ve but is that is it really worth while and
the caveat I always stay is specialty care is not always the answer the more and illustration I have here is just you
know the idea up too many cooks in the kitchen so when
you start fragmenting your care upon other people I mean the job your primary care
providers to be the quarterback so to speak so to keep tabs on who you’re seeing
what they say how things are changed but when you have
one person that’s you know your hypertensive spot
specialist the cardiology department and they make some change your blood
pressure medication and then you see the kidney experts in the fraud department
and he says oh your kidneys can’t handle that medication let’s change the dose on
that again and then by the time you come to see me
for your follow-up I have no idea what does your supposed
to be on or you know way it becomes very difficult as a provider to figure out what’s going
on much of a patient trying to understand all of this and so the more that you can have
managed by 1 provider the better and if you do need
to see it you know other special think that’s
reasonable and that’s fine but just keep in mind that complications
come with that the one thing I would say and this is
not me promoting Stanford are saying you need to do you get all your care at
Stamford because I’m biased towards Stamford I save it if you are going to see a
specialist it should try to be within the same
health system only because it easier to keep track of everything if
if I’m seeing you in the Stamford system and you had an MRI its acquire hospital
and then you had a you had your gallbladder out El Camino
Hospital that much more difficult for us to track
down all the details regarding that and what medications that changed when and
what you should be on are not on then if you how love it down here and I
can simply go and hear char NC what each of those things where that
happened what the outcomes were and make an informed decision about what
should you still be on what follow-up do you need and where do
we go from here go that’s the general overview love a what what you need to think about
when you’re actuar at your first visit if you do take my
advice and and consider really establishing healthcare baseline on you might talk at my dog she about it help you think on but I’m happy to take any questions
that you folks have yep questions what what if you could have
received up what’s up so up it question teen here’s yeah amino acid ship for so so the question in general I and
II wall repeated verbatim by it it’s essentially how do you go about coming up with what
questions you should be asking your provider’s example given was for a a surgical
procedure for instance you know I a a spinal fusion you know watch question should be asked when you speak
to your surgeon or your primary care provider and I think the first thing to consider
is who you’re asking the questions to you Sophia very specific questions about a
very specific procedure for instance what the average time to recovery for
this procedure that may be more reasonable for the
surgeon where they’ve if it you know have you
had other patients that have this procedure and how they do go I could probably be answered by their
either person I I think the easiest way to start it’s
just think about okay what do i do my daily life now and
how is that going to change so I get up I get dressed I’m able to do
that by myself after I have the surgery I you know make my own breakfast backing
to be a problem am I gonna be able to go grocery shopping am I gonna be in a lot of pain when I’m
done with this my gonna require medications that may be will make it
more difficult for me to do these things I go to work my gonna be able to go to
work how long will I be of a war for and how
is this going to work out with my employer is their paperwork will need to be
completed to get into my employer and then I you know drive to the grocery store again am I
going to be a able to drive well I need to have you know a
significant other drive me or a family member or well transportation be
required you can think even more broadly and well
I’d be safe in my own home you know if i if you live in you know
what level enormous home and you won’t be able to
walk and that may not be reasonable you may need to think about on is am I gonna be able to go home
after this procedure I’m for just starting to think about you
know the daily life and then or specifics
regarding the procedure itself most surgeons discuss those things risks
benefits you know things commonly seen that part
of your pre-operative process but I’m you know it’s not just worth
discussing with your surging copping you if you have other
medical issues or if the major surgery they will want a primary care provider
to give you a pre-operative clear so just a check over
to make sure that here in good health here medically
optimize as we like to say so all tuned up in the best shape you can be before
your surgery and in there so it’s hopeful look you
have someone who knows you who’s been following you and can say you
know your pressures band a little high for a while
but it’s been pretty stable I don’t think there’s a need to change
your medications now and I think it continue to take their
medications until the day before your surgery come see me when you’re done and we’ll
talk about your blood pressure medicine again as opposed to you walk into someone’s
office who’s never seen you before you’re nervous you’re having pain from
whatever wrong that needs a surgery your blood pressure is thru and then
that person to walk to wonder this guy have chronic high blood
pressure or is this just a situational thing and things like that can make a real
difference in in how you approach your surgery yep perceived three days I should years what sized place always major here going here’s answered I guess should is mort for he just and the other thing to think
about is you know talk to the staff at your surgeon’s
office you know have they seen other other patients that have had this
procedure what are some the challenges that they face turned out with or what you what to pick people typically
look like when they come back their follow-up appointment what can I
expect and of course there’s always your own risk-benefit evaluation is it worthwhile
to to even have a fan base a procedure and and that again a discussion on
dialogue should be yes sir here people said this humorous his still first years weaves most foresees I’d his yes to earth his work first who so this gentleman is voicing the
common concerns that many people that are part of the clinic that are
primarily staffed by trainees here so medical
student medical resident and fellow and his his concerns are that you know when you show up at many
clinics you never see the same doctor every time and that you you know see someone for the first 15
minutes at Rainier a medical student and then whatever covering attending physician is
there I’m come then and and in can really give me
the impression that your carrots fragmented and that is that is kinda par love the be I’m medical education I affect our up many of Stamford clinic I’m it can be difficult right different they say trip Road said he just made the excellent point up the the pro side having a trainee clinic
which is you have although it’s different people
the with the with the advancement a medical
records they’re able to review everything that is has been done by previous
providers many times because they’re seeing the patient for the first time they’ve done a more thorough review oh
that have a physician who may be used to seeing you in hasn’t been
as is is up-to-date on-the-record and you get a
fresh perspective on on your medical care and what they
think and there if the continuity that inbuilt
into having its record that’s available for whatever provider is there reviewing your your chart so their
pluses and minuses to do it I think the important thing is to know
what do you prefer are you okay with you know helping to enrich the educational a medical
trainees at expensive the continuity of seeing
the same person are you someone that really wants to see
your you know your doctor your NP every time
and then I’m you know have that kind of
continuity and and I think that’s something to
consider both types the practices exist here and in other health systems around around the
area and just keeping that in mind as here as you’re pursuing who you’d like to establish her care
with is there is certainly important consideration visions there’s opposed we asked what percentage a stand for patient have a regular a
regular doctor so to speak as opposed to a trainee clinic I’ll be honest I don’t
know that that is not a number I’m familiar with I
will say even in my office where I am primary provider in CMOS to my patients
most the time I do have fellows with me once a week I do have medical students that come
through and so even though I would say I’m probably not in that training clinic setting there’s
still a chance that if you came to see me you would see a trainee first I might I think the take-home point
there though is that again the if you keep your care within
wine location where all the records are there it certainly does help to form some for
a continuity whether it’s the same person or just the the same chart there that can be
rabin having quest here said or see which whether you’ll be in this
situation said the question how do you find that out if
you all be seeing the same doctor every time or whether you’ll be involved with
trainee I think it’s a safe assumption to think
that at some point if you are seeing a provider here
Stamford you may be seeing a trainee I’m at least initially as I said you know I have trees come through all
the time and so although my my patients generally see me on a regular basis there’s always the chance that a medical
student may see them first the best way to find out is when you
call the established care after-care corny that you’re speaking with you know is this a primarily non
teaching practices usually the best way to call a non
teaching practice a or will this be a teaching practice our
our resident clinic or things like that but kinda
asking is that the teaching practice is a good way to to establish before you even established
care what am I in for when I show up any other questions go huge milic said you know for the same program this head you have a record that part America
Foundation UCSF and Stanford are they really all available I and the
answer is technically yes as I said we have
through epic which is our epic is the name of
our électronique medical record that we use and those other entities also have epic and their is an up a its every week that
I will say we’re probably in the beta testing & version although they may say otherwise
obvious care everywhere program where be
radically I should be able to pull up your record followed those places by logging into your chart and in
Stamford a pic this time again as the you implement technology
there’s always you know a difficulty not everything will be
there certain things may not be present especially if they’re older you know the character were only
covers a certain charm a your chart so if you’ve been seeing
someone at UCSF for twenty years we may only have your last five years
with information from that provider so it’s not perfect there is still going
to be forms to sign faxes to and you note stacks of paper to sort
through it is not a perfect system by any means I’m by it’s a work in progress and I would
say it’s come a lot farther and the last you know five years
has have previously and I think it’s going to continue to get better and and hope help to streamline care in
general no thank you all for coming out

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