Need more time with your doctor?

Need more time with your doctor? In today’s hurried world both the doctor and the patient can feel frustrated by the amount of time available to speak with each other. Did you know that the insurance company rarely pays for more than a 15 minute visit with a primary care physician (PCP) unless the patient has a diagnosis they think should take longer. Even then extra documentation is required to show why it would take so long. Its ironic that they pay specialists for more time (even when it is a pop in and “keep taking the same medicine” visit) than they do for PCP’s who are supposed to be on the frontline and have a deeper understanding of you and your family’s overall health. I recently admitted a critically ill patient who had just returned from overseas and the insurance company refused to pay for my hospital visits to take care of him. Even though they saved a bundle by not having to pay specialists. They said his care is covered by the $20 a month they pay me for capitation. Small wonder most doctors don’t bother to take care of their own patients in the hospital anymore. They simply turn them over to a hospitalist who doesn’t know anything about them, kind of like a mechanic who only handles exactly what is in front of him. I recently returned from a conference (way out in the Boonies!) on alternative medicine and once again learned fascinating information I would love to share with my patients. But where is the time? While I am at conferences I keep thinking “wow! So and so may really benefit from that”. “I wish I had known that before so and so had that surgery” “I have a zillion patients who complain of fatigue, fibroids etc…If only I could have more time with them” When I come back I always like to meet with my VIP patients to discuss how new information may help them and what changes we can make to their vitamin regimens. Unfortunately I cant do that with everyone, however, if you feel that you would like to schedule a private self pay consultation with me please call the office. I am bursting to share the great news of how to improve health with everyone. Believe me my own regimen changed last weekend! Here’s to real health and vitality.

Latest mammogram recommendations

I have been asked by some patients what my thoughts are regarding the new mammogram recommendations. Quite frankly they don't make sense to me and will not change my current management of patients at all. Why?

Well first of all they are exactly what they claim to be "guidelines", I can choose to follow them or not. In this case I would rather not.

Mammograms are problematic from the standpoint of radiation however I have seen MANY patients diagnosed with Breast Cancer as a result of them. One of the most concerning trends has been the discovery of breast cancer in younger and younger women, the idea that they would not be diagnosed because they would delay their mammograms to the age of 50 is scary.



The bottom line is, as with most things in medicine, tailor the recommendation to the patient. It is important to have an on going relationship with a physician who knows you and who will make recommendations based on his or her knowledge of you and your particular situation, not based on guidelines. For example prolonged use of certain contraceptives, family history, breast exam findings are all things that would change how often and when a particular patient should get a mammogram.

Remember guidelines come and go, they are not set in stone and neither is your wellness. It should be a dynamic process arrived at by rational thinking and on going education.

When insurance companies finally start paying for thermograms we will have alternatives that don't involve radiation that may be more appropriate for some patients.

Until then for most people mammograms are the best they can afford ......
If you are at high risk remember to avoid caffeine, take indole-3, do regular self breast exams, do not take Provera and follow your doctors screening schedule.



Wishing you a healthful 2010

Dr Tuakli