Updated : 08/22/2008

General Information 

Our goal is to offer comprehensive primary care for people of all ages, with an emphasis on accessibility, continuity, and patient service.  Patients can schedule appointments for routine care, and adequate time is also set aside each day to ensure that patients can obtain same-day care for urgent problems.  Both physicians are available after hours for problems that arise unexpectedly and minor emergencies.  We also provide care for visiting guests of established patients and makes house calls within Celebration for those who are homebound.

John A. Pfeiffer, M.D., has lived in Celebration since 1997.  After practicing in Akron, Ohio, for 16 years, he relocated to Celebration in order to return to a small town atmosphere and influence the direction of family practice by establishing a practice that continues the best of the old "town doctor" with the addition of modern technology.  

Matthew L. Smith, M.D., started working with us in July, 2008.  With over 10 years in his hometown in Indiana, the start of his practice here offers to satisfy the longstanding need in Celebration for a pediatrician.  His addition signifies a new vision of primary care that recognizes a new primary care synergy between 2 previously competitive specialties.

About the Staff....

In the news....

Health items of interest....

• Just in time for flu season, the CDC has release their on-line 1918 Pandemic Flu Storybook.  "The online storybook contains narratives from survivors, families, and friends who lived through the 1918 and 1957 pandemics.  The 1918 flu killed more than 50 million people worldwide including an estimated 675,000 people in the United States, more than all those who died (both military personnel and civilians) during World War I (1914–1918).   I would also recommend an episode of PBS's The American Experience

• ...old stories

Immunization Update....

    The state of Florida requires all children entering kindergarten to be immune to chicken pox, either through the disease itself or immunization.  All children who have not had chicken pox must, for the first time in 2008, have had 2 doses of Varivax (chicken pox immunization).  Presumably next year this will be required for K-1, the following year K-2, etc. until all children in all years are immune.

    The CDC has added the pneumococcal vaccine (Prevnar) to its list of recommended vaccines for all children.  This immunization, given at 2, 4, 6, and 12-15 months, is designed to prevent respiratory (primarily ear and lung) infections and 1400 cases/year of pneumococcal meningitis (other types of meningitis are already addressed by the HIB immunization).  

• Efficacy of a Pneumococcal Conjugate Vaccine against Acute Otitis Media

    It is similar in many ways to the Pneumovax that is recommended for adults who are over 55 or suffer from a significant illness.  In fact, there are some who feel that the Pneumovax can be used for children over 2.
    The drawbacks?

• it costs as much as $75/shot wholesale.  Fortunately, it is covered by most insurance plans.

• it adds to an already crowded list of shots - 3 (DTaP, HIB, IPV) at 2 & 4 months, 4 (DTaP, HIB, IPV, Hepatitis B) at 6 months

Objective

"The family physician should be the cornerstone, rather than gatekeeper, in health care. A medical practice should focus on understanding and meeting the needs of its patients, while at the same time educating patients about the nature of their health needs. This can be even more successful, rewarding, and fulfilling when done in the context of a community such as Celebration."

 We've been asked.... 

Does Dr. Pfeiffer still drive the monorail?

Uh, no.  Unfortunately, it is hard to get out and do it very often. 

What is that little thing you use to write prescriptions?

It's an Palm Tungsten C.

It has been supplied to me by a company called Iscribe, which has developed a prescribing program that:

• prints legible prescriptions

• tells me what is on your formulary

• keeps a record of whatever I prescribe for you

• allows me to refill prescriptions from your record without rewriting them

• will soon (hopefully) email your  prescriptions directly to your preferred pharmacy without even printing them

Illegible handwriting has been a major problem for pharmacists for a long time, leading to wasted time and medication errors.  I write neatly, but slowly, so this is a great time saver for me, especially when it comes to refilling multiple prescriptions.

Another problem that this addresses is the formulary restrictions of many drug plans.  Consider what can happen when I start someone on a cholesterol lowering drug (presume that several drugs from which I can choose are equally effective, cause the same side effects, are taken the same way, and cost about the same):

1. I can find out what drug plan you are on, locate the formulary for that plan, and peruse that little book until I find which drug is covered.

2. I can write for whatever drug I think might be covered and have the pharmacist call and interrupt me to find out if it is okay with me to use a "formulary" drug instead, while you have an opportunity to become very familiar with the multitude of personal care products that are now made.  ("Gosh, I didn't know that they still sold Brut!")  Hopefully, you decided to get your prescription filled before the office closed, by the way....

3. I can tell you that your insurance plan stinks and that you need the drug that I want you to have, regardless of the cost that you incur.

4. I can prescribe whatever drug I personally prefer, make myself look smart by nitpicking the difference between nearly identical drugs, and submit a request for approval of a "non-formulary" drug.

Let's face it, although choice "A" is the most reasonable, physicians often select "B", "C", or "D".  

In fact, there is usually no significant difference between the drug that we want to prescribe and another one that is on your formulary, and, if we are able to know which one is on your plan without wasting a whole lot of time figuring it out, we would just as soon prescribe what is on your plan and save everyone a lot of time while minimizing your out of pocket cost.  

This device does that for me.  It also makes it easy to fax your prescription to the pharmacy, so that it is ready when you get there.

You might still want to buy some Brut, however; after all, Muhammad Ali still wears it.

previous questions...

Articles of the Week

 Empathy, Warmth Can Be Potent Medicine 

By Suzanne Rostler

NEW YORK (Reuters Health) - In an era of brief doctor visits and high-tech medicine, it may be the development of warmth and empathy between doctors and their patients that makes the difference in care, study findings suggest.

The study, published in the March 10th issue of The Lancet, found that doctors who showed empathy and acknowledged their patients' fears and anxieties were more effective than doctors who kept patients at an emotional arm's length.

``A sense of partnership and trust should be nurtured and thought of as part of the healthcare package,'' said the study's lead author Dr. Zelda Di Blasi, of the University of York, UK. ''Unfortunately, the current system discourages continuity of care and does not allow enough time for a healing interaction.''

Di Blasi and colleagues grouped 25 medical, psychological and sociological studies of care delivery by the doctor's style of interaction with patients. In ``cognitive'' care, the doctor tried to influence or convince a patient about an illness or treatment, while in ``emotional'' care, the consultation was deemed warm and empathic and the doctor tried to relieve patients' anxiety and fears.

Although none of the studies looked exclusively at emotional care, four evaluated both cognitive and emotional care. Three of these studies showed that support and reassurance enhanced health outcomes as measured by blood pressure readings and patient reports of pain. Of the 19 studies that investigated cognitive care, only half demonstrated significant effectiveness.

``In a healthcare consultation, doctors can offer social support to patients, give them a safe space to open up and discuss their problems and reassure them with a diagnosis or a treatment, thereby relaxing them and lowering their anxiety,'' Di Blasi said. ``All of these ingredients have been linked with immune function.''

The study should be a wake-up call to doctors, writes Dr. Chris van Weel from University Medical Centre St. Radboud in Nijmegen, the Netherlands. While acknowledging that the overall effects on patients' health were fairly small, ``the effects of the relationship on the course of illness indicates that the context of care influences patients' well-being,'' van Weel writes in an accompanying editorial.

SOURCE: The Lancet 2001;357:757-762.

(full article)

 Drs. Spend More Time With Patients 

The New England Journal of Medicine -- January 18, 2001 -- Vol. 344, No. 3

By JEFF DONN, Associated Press Writer

A new study disputes the widely held notion that managed care has put a heavy squeeze on the amount of time doctors are spending with their patients. If anything, office visits may be getting longer.

The study, based on surveys of doctors and their staffs, looked at more than 200,000 office visits over 10 years.

The average length of an office visit climbed two minutes between 1989 and 1998 to 18 minutes, based on surveys done by National Center for Health Statistics. It rose by one minute, to about 21 minutes, based on surveys done by the American Medical Association.

``Doctors have always complained about not having enough time for patients,'' said David Mechanic, a Rutgers University sociologist who led the study. With the rise of managed care, ``now they have somebody to blame for something that always existed.''

The study was published in Thursday's New England Journal of Medicine (full article).

Managed care patients accounted for a growing share of office visits during the period, climbing from 15 percent to 33 percent. Yet the average time spent by doctors during office visits was roughly the same whether patients were covered by managed care or traditional insurance.

Though doctors widely complain that patients are getting shortchanged, some studies suggest that patients themselves are generally satisfied with the care they get. Many patients say they would like more time with their doctors, though. And politicians have joined in the complaints.

``The rhetoric in the political arena is really too simple. It describes the situation in the health care system on anecdotes, not on reality,'' said Karen Ignagni, president of the American Association of Health Plans, which represents the managed care industry.

The Rutgers study was funded by the Robert Wood Johnson philanthropic foundation. Mechanic, who directs Rutgers' Institute of Health Care Policy, said he is not on the payroll of any managed care group.

The researchers did suggest some changes in recent years that may have placed more demands on doctors' time. Doctors are also treating more complex cases during office visits instead of in the hospital. They must evaluate an ever-broader range of treatments and do more preventive care, advising patients on smoking, obesity and other dangers.

With the expansion of the Internet and drug advertising, many patients are also asking more questions, doctors said. With the rise of managed care, many doctors also complain of too much paperwork.

``Office visits seem short because there is more to do, more to think about, and more that is expected,'' said Dr. Edward Campion, a deputy editor at the journal.

Dr. Jerome Kassirer, a Tufts University professor and former journal editor who has written about doctor morale, said the study carries a few potential sources of error. For example, the length of office visits was not objectively measured but was instead reported by doctors or their staff.

However, he said, ``I have a perception that doctors feel rushed not only with respect to seeing patients, but also with lots of administrative and bureaucratic activities.''

 Same-Day Appointments: Exploding the Access Paradigm 

Family Practice Management, September, 2000

The access model we created is often called "open access," "advanced access" or "same-day scheduling." It has one very simple yet challenging rule: Do today's work today. Doing so enables patients to see their own personal physician on the day they call for any problem, whether urgent, routine or preventive. In less than one year, it reduced our 55-day wait to just one day, it increased dramatically the odds of patients seeing their own personal physician, and it improved physician, patient and staff satisfaction. We are even gathering evidence that it improves clinical outcomes as well.

This is the successor to a previously featured article, "As Good As It Could Get : Remaking the Medical Practice".  It focuses on the importance and means of creating better access to office care...(full article)

previous articles of the week

 Scam of the Week 

Canola Oil Is Hazardous to Your Health!

Yet another in the series of "everyday things that can kill you".

previous scams of the week

Going around....