1. Empowering Your Health Care Clinton Evans, D.O. Family Medicine September 8, 2012

2. Objectives *Understand the landscape of health providers and how health care is delivered *Understand Acute Care versus Preventative Care *Better understanding of how to talk to your health care provider *Know Common Preventative Care Measures *Learn some current useful tools to manage your health care

3. Delivery of Health Care

4. Office versus Hospital Office Acute, non-emergency problems Preventative care Hospital Specialized care for acute illness and complex problems Surgery Center Same day surgeries, colonoscopy

5. Health Care Providers Who provides your health care? MD, DO, NP (FNP), PA, RN, LVN, RD, CDE, MA, CNA Primary Care versus Specialty Family Doctor, Pediatrician, Internist Surgeon, Gastroenterologist, Dermatologist, etc Hospitalist – internal medicine or family medicine Board Certification

6. What to expect at the office visit Front office staff Collect personal information Collect payer information – insurance Medical questionnaire forms Back office staff MA, referral coordinators, billers, office manager LVN, RN

7. What to expect at the office visit Average wait time: 15-19 minutes * Average office visit time: 15-20 minutes * Average time until doctor interrupts patient: 18-23 seconds ** How do these times effect your visit and care? * American Medical Association ** Beckman and Frankel

8. Talking to Your Doctor Initial presentation What/Who to bring with you to an office visit Health summary What/Who not to bring What kind of medical problems do you have if any? Advice outside of the office visit

9. What Medical Issues are Addressed

10. Acute Problems Acute problems How long until you go to be seen Too early or too late The Win-Win Scenario –treating at the moment of care Emergency The ER has a purpose

11. The Preventative Care Visit How often – increasing frequency as you age * Increasing screenings as you age Efficiency of information gathering The ideal – indefinite time for discussion Reality – limited time to meet the needs of all

12. Preventative Measures Age specific – Pediatric through Geriatric Immunizations Tests and Exams Weight Vision Hearing Blood Pressure Heart Cholesterol Diabetes Colon Breast Cervical Prostate Bone Density Skin Cancer

13. Organizations with Preventative Recommendations National Guideline Clearinghouse USPSTF (U.S. Preventive Services Task Force) CDC (Center for Disease Control) Department of Health and Human Services Women: Stay Healthy at 50+ Men: Stay Healthy at 50+ American Academy of ___________________ American Cancer Society National Cancer Institute

15. Your Personal Health All health starts with how you treat yourself Weight management Daily exercise Healthy diet

16. Screening Test What is a screening test? What makes a good screening test? Risks versus Benefits Specificity Sensitivity

17. Why are some tests not used to screen? Answer: insufficient data to support routine use as a screening tool Example: Cancer antigen tests PSA, CA-125 – both can increase in benign conditions How can they be useful?

18. Blood Pressure (Hypertension) Annual or Biennial When to treat 140/90 (Systolic / Diastolic) How to treat First line is always lifestyle – weight management, diet, exercise Low salt intake Medication

19. Colonoscopy Starting at….. Age Risk Factors How often? What to expect Related screening tests – hemoccult, fecal DNA Virtual colonoscopy

20. Diabetes Universal screening has not shown an impact Risk factors do play a role for screening Obesity Family History Other existing health problems Primary disease prevention has the greatest impact

21. Breast Cancer Clinical Breast Exams Self Breast Exams Mammograms Screening Diagnostic Ultrasound Breast MRI Breast Cancer Awareness Think Pink Originated here in Redding!

22. Cervical Cancer What causes cervical cancer? Most consistent link = HPV (human papilloma virus) What is a pap smear (Papanicolaou smear)? How often do you need a pap smear? When can you stop getting a pap smear? What about the clinical exam? Prevention also includes HPV vaccination – ages 9-26

23. Prostate DRE – digital rectal exam PSA

24. Cholesterol (Lipids) Atherosclerotic Vascular Disease Total cholesterol, HDL, LDL, triglycerides When to start: based on risk factors Includes family history, habits like smoking, age

25. Skin Cancer The most common Cancer Yearly skin exam? Prevention should start as a child Protection from the Sun!!! Cover up, Sunglasses, Sun Screen Incidence of melanoma = about 20/100,000 in 2008 for California UMSkinCheck – smart phone app

26. Using Technology Computer Resources Smart Phone Apps Blood Pressure Logs Blood Sugar Logs Exercise Apps Diet logs Weight and BMI tracking

27. Using Technology, Continued… THE SELF DIAGNOSIS THE FAMILY INPUT DIAGNOSIS THE “My best friend’s, brother’s, girlfriend’s, dad’s, cousin’s friend has these same symptoms with this disease” DIAGNOSIS LEADING TO: THE INTERNET DIAGNOSIS Yard Stick example

28. Smart Phone Apps

32. Using Reminders Apple – RE.minders Android – Life Reminders Black Berry – Role Call Reminders

33. Creating a Health Summary Your own document Apps – example: PocketEHR (free version), My Medical Info Online portals My Family Health Portrait - familyhistory.hhs.gov Health Vault – by Microsoft EHR portals through your doctor’s office What to include: Past history including current and prior treatments and surgeries Family History – immediate family generally most important Social History – example: smoking history, alcohol consumption Medications Allergies

36. Organizations with Preventative Recommendations National Guideline Clearinghouse USPSTF (U.S. Preventive Services Task Force) CDC (Center for Disease Control) Department of Health and Human Services Women: Stay Healthy at 50+ Men: Stay Healthy at 50+ American Academy of _________________ American Cancer Society National Cancer Institute

37. Summary Be your own advocate for your health starting with taking care of yourself Ask questions Preventative measures – think of it as a guide Keep your own record