Is the milk you drink rBST-free? Is your physician board certified?

Many people take the time to buy hormone free milk, but they don’t make an effort to choose a physician who is board certified. That’s a shame.

Asking a friend or family member might be a good way to choose a hairdresser, but it is not a good way to choose a physician. Medicine is difficult. The same way that you want the pilot of your next flight to be maintaining his or her skills and knowledge of flying, you also want your physician to maintain his or her skills in medicine. The truth is, you are much more likely to die from your doctor’s mistake than from a pilot’s mistake.

Being board certified is no guarantee that your physician is good (or nice!), but it does assure you that your physician is committed to continuing education and is learning advances in medicine. It also assures you that your physician has completed the necessary training and passed a certification exam for the field of medicine he or she is practicing. Having a license means only that they completed the minimal requirement to practice medicine. Maintaining active board certification means that your physician has undergone yearly continuing education and has passed a re-certification exam every few years.

Certainly there is more to being a good physician than completing residency and passing written and oral examinations. But studies show that high exam scores do correlate with practicing better medicine.

There are 24 board specialties. You can check to see if your physician is board certified by going to the American Board of Medical Specialties site at ABMS.org, registering, and putting in your physician’s name. It is a free and confidential service. You can have a nice glass of rBST-free milk in the meantime.

Post written by Dr. Jeffrey Benabio, Copyright The Derm Blog 2009.

Photo: Ingrid Taylar (flickr)

How many patients never fill the prescription for a medication given to them?

A. 2%

B. 5%

C. 13%

D. 22%

E. 30%

F. 68%

Believe it or not, its E. 30%.

A study published in the Jounal of the Americal Academy of Dermatology found that nearly 1 in every 3 people never fills the prescription medication that was written for them!

There are many reasons why. The most important is that there was a breakdown of trust between the physican and the patient. If a patient does not feel that his or her doctor’s diagnosis or treatment plan is helpful, then he or she will be unlikely to fill the prescription. Also, if a patient does not understand the diagnosis or treatment, then it’s unlikely they will be compliant with taking their medications.

Even if the patient trusts the doctor and understands the treatment plan, prescriptions are expensive! If you have a limited budget and the prescription for a rash costs $75, you might have second thoughts — do you really need to treat it?

Most of the chronic skin conditions I see in clinic could be treated if people used their prescription as directed. However, like eating a good diet, excercising, and getting 8 hours of sleep, taking prescriptions is difficult.

• Physicians have to take the time to properly diagnose you and to ensure that you understand your condition and how to treat it. 
• Your physicain should ask questions at the end of the appointment to ensure that you understand. Getting a hand-out with written information about your condition, about your medication, and instructions on how to use your medication is also important. 
• Physicians should also consider cost; sometimes choosing a generic medication is much better than the  name-brand because the patient can’t afford the new medication. Using a generic medication is in most instances just as effective as a name-brand and is certainly more effective than not using a medication at all. 
• Having patients return to clinic within a week or two of a new diagnosis is also a great way to reinforce medication use and to help encourage patients to continue their therapy. 

• As patients, it is your job to help yourself. Keep a written record of when you have used your medications. Be honest of course. 
• Set your medications aside in a weekly pill box so that you are sure to take your all your pills everyday.
• Make note of how many days you did not take your pills in the last week. 
• Most of the time when a medication seems to stop working, it is because you have stopped using it. Seeing your physician for a new prescription is often more likely to waste time and money than it is to make a difference in your condition.

Are you taking your medications? Probably not.

In a recent dermatology study, a mere 50% of adults and 30% of children were still using their medications 8 weeks after they were prescribed.

But what if I sent you a text to remind you? Would you be more likely to take your meds or use your creams?

Taking medications or applying creams takes effort and discipline. Unless you form a new habit and apply your medication or take your pills at the same time everyday, it is unlikely you will persist. It is similar to exercising — if you exercise at different times and different days, then it is much more difficult to stay exercising than if you developed a habit and did it as part of your daily routine.

There might be a new way to help encourage people to get into a habit of taking their medication everyday: text them.

A recent study presented at a Society for Investigative Dermatology meeting showed that texting patients actually improves compliance (that is, the likelihood that they will take their medication). In the study, 70 cell phone users were randomized to receive a text message reminder to apply sunscreen everyday or to not receive the text reminder.

At the end of 6 weeks those who received the text reminder were more likely to apply their sunscreen as compared to those who did not receive the text. In the text group, people used the sunscreen 56% of the time while in the control group they used it only 30% of the time.

The researchers cleverly attached the weather forecast to the text message to make the message more useful and to encourage people to open the message and read it. The act of opening and reading the message everyday helped them get into the habit of applying the sunscreen everyday, improving their compliance.

In my practice more and more patients use email to communicate with me. Texting might be another way to communicate with patients to help them be more compliant with their therapy.

You can’t text me, but you can twit me if you like.

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Photo: Sintex

YouTube, with over 80 million videos, has become a popular resource for health information. But is the information provided helpful?

This video has had over 81,000 hits. In his 5 minute lecture, the expert describes:

1. The need to take Cod liver oil with vitamin A to prevent a vitamin D overdose.

2. How the real danger in tanning beds is not the ultraviolet light, but rather an electromagnetic field from magnets.

He goes on to describe how this “radiation” or “rays” or “field” (he cannot decide) causes “significant disruption in your energy field … and increases your risk of cancer.” He advises you to find a tanning beds that uses electronic rather than magnetic sources, because electronic tanning beds are “very beneficial” to your health.

OK.

First, in order to overdose on vitamin D, a healthy adult would have to take about 50 vitamin D tablets (50,000 IU) a day for months. There is no relationship between vitamin A intake and vitamin D absorption.

Second, there is no evidence that magnetic fields are dangerous. MRIs generate magnetic fields 45,000x greater than the earth’s magnetic field. (A new MRI can generate 9.4 T, which would be over 280,000x stronger than the earths magnetic field!) There is no evidence that even these superpowerful magnetic fields increase your risk for any type of cancer.

It is, however, well documented that ultraviolet light is carcinogenic. Tanning beds cause premature aging, discoloration of your skin, and increase your risk for developing melanoma.

Physicians need to take better advantage of online media to educate people and consumers need to develop critical thinking skills. Just because an “expert” gives a lecture on YouTube, does not mean the information is helpful (although I did find it entertaining).

I need to get a video camera ….

1. Make a list. It has been said that doctors don’t like when patients come in with lists — it’s not true. A list is the best way to ensure all your needs are met. However, anticipate how much time each problem will take. If you have a list of 15 things, and we only have a 15 minute appointment, that means we have to cover each item in a minute or less. If you know you have a lot to discuss, then ask if you can book a longer appointment.
2. Start with the most difficult issues first. Too often patients wait to the end of the appointment to bring up difficult or embarrassing issues. Research shows that patients who bring up difficult issues at the start of an appointment are more likely to be satisfied with the visit and to adhere to their doctor’s recommendations.
3. Know your personal history. You will likely change insurances and doctors several times in your life, so it is critical that you have a copy of your medical history. For example, I saw a patient yesterday who claimed to have a history of melanoma — in fact he had a basal cell carcinoma – there is a huge difference. Giving the wrong history can affect your treatment, prognosis, and your ability to get insurance in the future.
4. Know your family history. It is important in determining your risk of disease and can sometimes help diagnose a condition.
5. Bring your medications. A typical exchange in my office: Me: “I am going to prescribe triamcinolone cream.” Patient: “Oh, I am using that already, Doc.” Me: “Well, let’s try fluocinonide cream then.” Patient: “No wait, flu-o-cino-something, yeah, that’s what I’m using now.” Me: “Are you sure it is not fluocinolone cream?” Patient: “Well, I don’t know. It’s definitely a cream though.” Two words: Not helpful.
6. Ask questions. It’s important that you understand what was said and what you need to do. Ask for instructions in writing before you leave. If you realize you missed something after then visit, then call or email your doctor.
7. Do your homework. It’s always helpful when you know about your condition. There are some great resources on the web and taking the time to learn will make you a better patient. Be cautious about self-diagnosing though (especially from pictures on the web!). It’s OK to ask questions of your physician, but it is rude to challenge them. Physicians spend tens of thousands of hours studying their field; be respectful of that — Google only makes it look easy. If you think your physician is wrong, then get a second opinion.

At your dermatologist’s office, don’t be afraid to mark spots on you that you want checked. Also, it can be helpful if you have pictures. Rashes change over time, so if you want me to see what it looked like at its worst, then take a few pictures. I actually had a patient who shot a short film of her skin problem — for the record, video is overkill (unless you bring Junior Mints, then it’s OK).

Post written by Jeffrey Benabio, MD. You might also like:

How to Avoid Razor Bumps

How to Stop a Shaving Nick From Bleeding

Are You Over-Scrubbing Your Face?

Skincare Myths: Plucking Hair Makes it Grow Back Thicker

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Most dermatologists do not perform surgery in a hospital operating room, but we do perform a lot of cutaneous surgery.

How much? According to data from Medicare and Medicaid:

• Dermatologists performed more excisions of malignant skin lesions than any other specialty.
• Dermatologists performed 454,012 excisions of malignant lesions in 2004 (the latest data available). This was four times more than the next closest specialty, Plastic Surgery, which performed 112,412 excisions of malignant lesions.
• Dermatologists also performed more benign and malignant excisions, complex skin repairs, flaps, dermabrasions, laser treatments, chemical peels, and Mohs procedures of any specialty.

Certainly surgeons in Plastic Surgery, General Surgery, Oculoplastics, and Ear, Nose and Throat Surgery are trained in skin procedures and have expertise and training in areas outside of dermatology.

But do dermatologists do surgery? Yep. We sure do.

Many thousands of procedures are done each year in doctor’s offices. The vast majority go smoothly and without complication. However, all procedures, including cosmetic, medical, or even Botox, have some risk. A study published in this month’s Dermatology Surgery summarized findings from seven years of data in Florida. In Florida all incidents of death, serious injury, or hospital transfer from a doctor’s office must be reported to a central agency. (Why don’t all states have this? They should.)

The authors found that in 7 years of collecting that there were 31 deaths and 143 procedure-related complications.

Of the 31 deaths, 18 were in patients undergoing a cosmetic procedure. The majority of the deaths and the complications that required transfer to a hospital were associated with liposuction, abdominoplasty (tummy tucks), or bundled procedures — when multiple procedures such as liposuction, abdominoplasty, or breast surgery are done together.

As a result of Donda West’s death, a new law has been introduced in California that would require all patients undergoing cosmetic surgery to be medically cleared by a licensed physician, such as their primary care doctor, before undergoing surgery. Although well intentioned, it is not likely that laws such as this would do much to protect patients. In Florida, for example, 78% of the deaths were in ASA Class I patients, which means they were healthy patients with no medical problems prior to the procedure. Having a doctor’s approval before the surgery, therefore, would not likely have made any difference.

Office-based surgeries are generally safe, but many of these procedures, especially those requiring general anesthesia have a real risk that must be carefully considered. Here are five tips to help you stay safe when undergoing any significant surgical or cosmetic procedure in a physician’s office:

1. Ask if your physician is board certified and if the office has surgery accreditation (this is voluntary in most places, but a good idea, especially if the procedure you’re having is significant).
2. Ask your physician how many times he or she has done this procedure and what complications he or she has had.
3. Tell your physician all the medications you are taking, including over the counter medications and diet supplements.
4. Tell your physician any risk factors you might have for blood clots including family history, smoking, and oral contraceptives.
5. Before you undergo any procedure, be sure that you completely understand what will be done and what the risks are. Anesthesia and blood clots are two of the more serious risks of surgery, and you should understand them completely before agreeing to the procedure.

Photo credit: Cyrill Vallee, Flickr.com

You might also like:

Is the Tanning Industry the New Big Tobacco?

How to Make a Chocolate Facial

Vitamin C and Skin Care

Skincare Myths: Plucking Hair Makes it Grow Back Thicker

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“Hello Dr. Benabio. Would you mind washing your hands?”

“I did just wash my hands,” I replied.

“I’m sorry, I didn’t see you wash them,”she retorted.

This is a problem. I always wash my hands before seeing a patient — either with soap and water, or with the antibacterial alcohol gel we have outside each exam room. But when I walk into the room, my hands are already dry. What’s a doc to do?

• Introduce myself, then quickly go over to the sink and start washing?
• Introduce myself by saying: “Hello, I’m Dr. Benabio. I’m sorry I’m late, I was just outside washing my hands”?
• Have my nurse say loudly before each patient, “Dr. Benabio, nobody washes their hands as thoroughly as you do!”

I think most of my patients trust me (my shoes are always shined). But a tip I saw from Skin and Aging might help in some instances. It recommended that doctors wash their hands then open the door with paper towel and throw the towel away in front of the patient.

Of course, then my patient might think, “Oh great, my doctor just came back from the bathroom.” Sometimes you just can’t win.

Total cost of those prescriptions: $27,387.14

Total cost of prescriptions for generic doxycycline: $750

Total cost of prescriptions for generic minocycline: $2,196

Estimated cost of prescriptions if I changed all my generic doxycycline to name brands such as Adoxa® or Oracea®: $19,500

Estimated cost of prescriptions if I changed all my generic minocycline to name brands such as Solodyne®: $23,504

Estimated savings by using generic drugs over name brand drugs: $40,000.

This savings is for two drugs over a three month period.

Physicians have a responsibility in controlling health care costs.