General Practitioners

• Medical Weight Loss
  Seems like a rather bleak scenario for an avoidable problem. Weight loss, especially when combined with even a modest exercise program can reverse many of the pathological physiologic conditions I outlined earlier. Hey, I'll even give you a twenty-minute head start like in the LA Marathon. If the goal is at least 30 minutes of modest exercise three times a week, starting off with a 10 minute walk and adding 5 minutes every week or two until you get to the 30 minute goal is what I suggest to patients almost every day. Any weight loss is better than weight gain, and the benefits in blood pressure, blood fats, insulin sensitivity and less wear and tear on weight-bearing joints and spine are clearly worth it. And you'll need doctors less, and perhaps even avoid taking the medications that you didn't want in the first place.
• Family Practice
  Coverage and Affordability. One of the greatest benefits one can have is healthcare insurance provided by an employer. However if one is unemployed, or employed by an enterprise that does not provide healthcare coverage or family member of such an individual, that person is one of 45 million Americans without healthcare insurance, and there are many more millions who are under-insured for potentially devastatingly costly care. Healthcare benefits are often at the core of labor disputes. Workers want healthcare coverage, often in lieu of wage increases. Businesses may want to provide healthcare benefits, but at a cost they can afford to remain profitable and competitive. Businesses may offer less expensive (to them) managed care (HMO) plans with less choice of provider and benefits, and/or attempt to shift more of the cost to the employee. Even though there has been an average 12.4% increase in earnings for those with jobs since President Bush took office, there has been a 36% increase in workers' costs for healthcare insurance, often with diminishing benefits. The average worker now pays more than $220 a month for family health insurance. How the candidates propose to provide affordable, quality healthcare is a topic we will explore in Part II.
• Emergency Care
  Now you or your loved one, fortunate enough to have insurance, require hospitalization. Unwilling and unable to absorb the entire cost of the uninsured patient's care, the hospital tacks a surcharge to all of your services, hoping to make up some of its lost revenue. If this is a for-profit hospital, the charges may be even higher since their investors will not tolerate losses. This phenomenon is called “cost-shifting”, and will increase your healthcare premiums even if you have not had any claims. Ever. And the tax-supported county hospital cannot afford to provide care either, but is often the only source of care for the uninsured. The emergency room is ground zero for the cost of caring for the uninsured. This is why trauma departments, emergency rooms and whole hospitals go out of business. Hospitals cannot care for more uninsured patients that consume diminishing profits.
• Electrocardiogram
  There are different types of stress testing that each has its role in sorting out the status of a patient's coronary arteries. The most basic is the routine treadmill or bicycle exercise test in which a patient's symptoms, electrocardiogram, blood pressure, heart rate and rhythm are monitored with increasing levels of standardized exercise. If the arteries are having a hard time supplying heart muscle with enough oxygen and nutrients with increasing demand, the patient may develop symptoms, electrocardiographic changes, or instability of blood pressure or heart rhythm.

Internists

• Internal Medicine
  The issue of under-treatment of patients at risk for cardiovascular disease was again highlighted in a study published in the January 14 2003 Annals of Internal Medicine. This report demonstrated that drug treatments that have been unquestionably beneficial are not being prescribed in the prevention another heart attack in patients who have suffered a first event, but even in the prevention of the first event in patients at risk. Moreover, there seems to be a disproportionate number of women who are not getting the treatments. What is particularly irksome is that many of the clinical trials have shown that women benefit even more than men when given these therapies.

Radiologist

• Ultrasound
  Last week a lot of health media attention was focused on a story of a new approach to reverse atherothrombosis, the process that eventually clogs arteries in the body and is the number one cause of death in the United States. A new agent was infused into a small number of patients with symptoms of inadequate blood flow to the arteries feeding the heart. Using an ultrasound technique to measure the volume of plaque in the walls of the arteries, the investigators found that measurable removal of plaque took place in a matter of weeks. Astounding. But what does this really mean?
• X-Rays
• Computed Tomography
  Consequently, if suspicious symptoms are noted, appropriate diagnostic studies need to be considered. Routine treadmill exercise tests have a higher incidence of false positive studies in women. This means that tests look abnormal when they may not be truly abnormal. For that reason, stress testing may be enhanced by concomitant use of echocardiographic or nuclear perfusion studies that increase their diagnostic accuracy. Increasingly, electron beam computed tomography, or calcium scanning, may play a role in sorting out risk of coronary disease, but not in determining the meaning of a given set of symptoms.

Dermatologists

• Ulcer
  The medications under fire are Celebrex and Vioxx, the available non-steroidal anti-inflammatory drugs collectively known as NSAIDs. Their primary use is in the control of the inflammation and resultant pain from arthritis. NSAIDs work through the blocking of an enzyme called cyclooxygenase. Cyclooxygenase (COX) protects the stomach from the ulcer-producing effects of stomach acid. Not surprisingly, blocking COX with NSAIDs has been known to increase the risk of stomach ulcers.