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Author Archives: Dr. Bob

About Dr. Bob

Over the years I have experienced the health care system from several points of view. I practiced Internal Medicine then developed & directed condition management programs guiding nurses in their conversations with people dealing with chronic conditions, such as asthma, diabetes and heart disease. About 8 years ago I ended up on the other side of the stethescope and experienced both the life saving benefits of the American health care system, as well as some of its frustrations. Since then I continue to work in the chronic condition arena and am involved with some of the more promising changes to our system. They say when you write a blog you should focus on a topic about which you are passionate. My experiences lead me to focus this For Your Health blog on these two areas, 1. Changing behaviors to lead a healthier lifestyle 2. Learning how to navigate the healthcare system Each of these can be thought of as learning how to self-manage your health and wellness. So here goes, I'm launching this blog in the hopes that some people will find my thoughts useful and entertaining. Thanks, Dr. Bob

Health Record Portability – Part 2 Some Progress To Report

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In my last post, I outlined the need for Health Record Portability as well as the obstacles to its widespread implementation.  However, there are a few inroads being made.  Here are some of those initiatives.

From the healthcare provider viewpoint, some communities have launched their own Health Information Network (HIN) that enables community physicians, hospitals, labs & other healthcare providers to share their information. You can think of it as a healthcare information utility that supports health information exchange.  This sharing is always dependent upon the consent of the individual patient.  One example with which I am familiar is the East Tennessee Health Information Network (etHIN) in Knoxville, Tennessee.  The hospital systems & physician practices pay a fee to etHIN to be able to share their patients’ health information.  One feature that would have helped me to keep track of my pneumonia vaccine is a Vaccination Gateway that etHIN provides.

But what can you do as a patient, especially if you live in a community without a health information network?  From a non-technological perspective, you can keep paper copies of your medical record.  Usually you’ll want to organize them by practice or medical issue, but if you have some condition that gets monitored by some lab test, you’ll want to group them together.

There is a more modern approach that you may want to consider if your physician’s EMR system supports it.  Microsoft has a free cloud storage application called HealthVault that can help you manage all your electronic medical information in one place.  Once you set up your account, you can ask your physicians (past and present) who use an electronic medical record to send your files to your HealthVault account.  Not all EMRs can provide your records in a format compatible with HealthVault.  It is far from perfect, but it is a beginning.  Hopefully we will see more EMRs that are compatible with HealthVault in the years to come.  You can also upload any records that you have scanned into your computer. A great feature is the ability to create an Emergency Medical Information card that includes your allergies, medications you take, health conditions you have and emergency contact information.  It also has access information so an Emergency Room physician can view your HealthVault record.  It can be folded to fit in your wallet or purse.

Next time I’ll share some examples of situations I’ve encountered where health information sharing just hasn’t worked and, in a later post, some possible ways to prevent these problems.  As always, please share your thoughts and comments.

For Your Health – Dr. Bob

Health Record Portability – Part 1 What Is It & Why Is It Out of Reach?

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It’s been awhile since I last posted. My apologies.  I’ll try to do better.  I thought retirement would give me more time to focus on this blog, but it seems to give me more distractions.  Since my last post, I’ve once again seen some issues with being a patient in our healthcare system that deserve some comment.  This post will talk about one that those of us who have moved around the country face – keeping track of our medical records, in other words, health record portability.  We may have paper records that we carry with us, but the more we have, the harder it is for our new physician to pour through them and incorporate them into the current record.

What brought this topic to my attention was my recent need to find documentation of a pneumonia vaccination that I know I received within the last few years.  Was it done at my doctor in Knoxville or was it done at a pharmacy while I was on vacation in Florida?  I can’t find the record of it within my paper files.

In this digital age, it seems that certain aspects of our healthcare delivery system have not kept up with technology.  Our medical records should be digitally portable.  If you had surgery in Richmond, VA and now moved to Charlotte, NC a lot of that information may not be readily accessible to your new healthcare providers.  What are the current obstacles?

  1. Not all physicians or healthcare providers use an electronic medical record (EMR)
  2. Not all significant healthcare information is contained in the EMR
  3. Not all the EMR systems that are operational can share information
  4. Even where sharing is possible, it’s often not automatic

Next time I’ll talk about some solutions that are on the horizon.  In the meantime, please feel free to share your comments and thoughts.

For Your Health! – Dr. Bob

Creating Your Weight Loss Plan – Part 4 Changing Behaviors & Keeping Resolutions

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With 2016 just a few days away, many of us are thinking about making resolutions for the New Year.  Well, resolutions are really behavior changes.  In the context of a weight loss plan, changing behaviors refers to changing what you have been routinely doing in regard to your eating and exercise routines.  You may also think of behaviors as habits.  Your weight is what it is because of your eating and exercise habits.  While your metabolism plays a significant role, your eating and exercise behaviors are the two areas that you can impact to change your weight.  You will either add new behaviors or substitute new, healthier behaviors for your current less healthy ones.  It is rare to just stop a behavior without replacing it.

Adding Behaviors

New behaviors involve adding something to your current activities, such as an exercise routine.  Often the main challenge is finding the time.  For some, it’s in the morning before the main activities of the day; for others, the evening makes more sense.

As far as exercise, the ultimate goal is spending at least 30 minutes most days of the week doing an activity of moderate intensity.  The more time you spend exercising, the more calories you will burn.  It has been recommended by the American Heart Association that from a cardiovascular health viewpoint, those 30 minutes can be expended all at once or in several blocks of at least 10 minutes each.    It makes sense to start slowly, so 10 minutes three days a week may be the perfect starting point for you.

Substituting Behaviors

These often revolve around eating behaviors.  For instance, instead of drinking sugary beverages, substitute water.  While this may sound simple, it takes planning to make sure you do it.  You’ll probably want to buy fewer sugary beverages and have them less accessible, too.  (Ideally, don’t buy any!)  You may need to put notes in your refrigerator on those sugary drinks that remind you to drink water instead.

As you create your weight loss plan, take some time and identify the behaviors you need to change and which ones you’ll tackle first.  Don’t try to change them all at once.  Make a list and change a few more every week or so.

Don’t forget to check out my website www.insightsforhealth.com where you can set up Health-e Texts to reinforce your new healthier behaviors.  To use some of these you must register as a member, but membership is free!

Your comments are welcome.

For Your Health! – Dr. Bob

Creating Your Weight Loss Plan – Part 3 Milestones & Rewards

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Just as you anticipate and prepare for barriers and obstacles to your weight loss plan, you should build in some rewards for milestones you reach during your journey.

Milestones

Milestones can be thought of as mini-goals that you must attain on your way to your ultimate goal.  If your ultimate goal is a target weight loss of 75 pounds over a 6-month period, then you can set your milestones in terms of process measures and outcome measures towards that goal.

Process Measures

In order to succeed and reach your weight loss goal you need to change habits surrounding your eating and activity (exercise).  These habits, behaviors, processes must change.  For example, you can no longer buy any food just because it tastes good at the grocery.  You must read labels and evaluate your choices.  As far as activity, you need to get on a routine of scheduled exercise.  So a milestone for eating habits may be consistently keeping a food diary or consistently reading food labels at the grocery.  As far as exercise, a milestone could be exercising for at least 30 minutes a day at least 3 days a week for at least a month.  Where possible, you will want to increase certain aspects of your new behavior to set a new milestone for yourself.  This is often done with exercise.  After a month of 30 minutes a day 3 days a week, you may want to increase that to 4 times a week.  But reward yourself as you attain each milestone.

Outcome Measures

These are usually tied to getting to a specific portion of your goal.  So, when trying to lose 75 pounds, your first milestone may be losing 10 pounds.  The next may be 25 pounds.  These milestones help you track your progress and allow you to reward yourself for the work you’ve done.  Changing behaviors isn’t easy!

Rewards

The ideal reward should be tied to the new behaviors you are undertaking.  In the case of weight loss, they certainly shouldn’t be unhealthy or off-limits foods.  So, you may get yourself some new workout clothes or exercise equipment.  For more significant milestones, a weekend getaway might be appropriate but without indulging in foods that are not on your healthy eating plan.  When you hit your ultimate goal, you’ll probably want to treat yourself to some new clothes that fit the new you.

Next time I’ll talk a little more about changing behaviors.

For Your Health! – Dr. Bob

Creating Your Weight Loss Plan – Part 2 Obstacles

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After identifying your Weight Loss Goal, Target Date, Start Date for your weight loss plan and support person, you need to identify potential barriers to your success and, most importantly, ways around those obstacles.  There are actually two kinds:

  1. The barriers that are likely to prevent you from starting your plan, and
  2. The challenges to following through on your Nutrition or Exercise Plans.

Barriers to Starting Your Weight Loss Program

This is a critical step.  Unless you accurately identify those impediments to start your plan and, most importantly, solutions to overcome them, you won’t even be able to start.

What are some barriers that might stand in someone’s way?  Well, for some there may be an upcoming event like a vacation or birthday that they may be inclined to use as an excuse.  For others, it’s the extra time and energy that must be spent in choosing healthier foods for their nutrition plan or needing to identify where they will be doing their new exercise plan.  If you consider each of these, they are solvable through a little extra thought.  You can start your plan during your vacation or just wait to begin after it’s over.  Ultimately, however, you will need to apply your new healthier eating and exercise habits no matter where you are.  As far as identifying nutrition and exercise plans, most people do that research during their preparation phase so on their Start Date they hit the ground running.  I’ll cover these in the next few posts.

Challenges to Following Through on Your Plan

Once you start your Weight Loss Plan, there will often be challenges to your staying on track.  They usually occur more often at the beginning.  As you learn to solve one, that same solution can often be used for others that come your way.  These challenges may arise from schedule changes that you will need to make, such as, when to exercise or where to find the time to keep a food diary?  By identifying these before you start your plan, you can devise strategies ahead of time so they won’t slow you down.  Another common example is what to do at work when there is a celebration where food is served?  Usually the foods aren’t the healthiest of choices.  There are plenty of candies, cakes & salty snacks, but fruit is a rarity.  One strategy is to eat only one or two items while drinking water.  The water can help fill you up.  Should the celebration be one that everyone is asked to bring in something to eat, you should be the one to bring in some healthier choices, such as a fruit or salad tray.

As you try to anticipate these Barriers and Challenges, don’t forget to discuss them with your support person to get their ideas.

If you have encountered any of these kinds of obstacles during your weight loss journey, please share them in a comment.  Looking forward to any comments you wish to share!  Also, don’t forget to check out my website www.insightsforhealth.com where there are tools to Make Your Plan as well as many other features to learn about nutrition & exercise.

For Your Health! – Dr. Bob