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John
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Updated : 07/26/2008Going around.... Fifth's disease - not a big deal In the news.... Health items of interest....
Immunization Update.... The state of Florida requires all children entering kindergarten in 2001-2 to be immune to chicken pox. All children who have not had chicken pox must have a Varivax (chicken pox immunization). 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).
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.
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. John T. Nonweiler, M.D., relocated to Celebration from Indiana in late 2003, after practicing in a rural county west of Indianapolis since 1972. He brings a wealth of experience from over 25 years as a small town family physician, including several years as a medical missionary to Bangladesh. About the Staff.... Well, now there are two.... 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? Yes. Unfortunately, it is hard to get out and do it very often. If you want to be notified when the next time will be, please email and we will put you on the "this I gotta see" list...... What is that little thing you use to write prescriptions? It's an IPAQ, Compaq Computer's entry into the handheld computer field. It has been supplied to me by a company called Iscribe, which has developed a prescribing program that:
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):
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. Empathy, Warmth Can Be Potent MedicineBy 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. Drs. Spend More Time With PatientsThe New England Journal of Medicine -- January 18, 2001 -- Vol. 344, No. 3By 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 ParadigmFamily Practice Management, September, 2000The 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) Scam of the WeekCanola Oil Is Hazardous to Your Health! Yet another in the series of "everyday things that can kill you".
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