Finding A Better Primary Care Doctor

16 April 2012 Janet Solie MS, PA, IHC

A dear girlfriend of mine two years ago developed a mysterious illness with a series of what appeared unrelated symptoms that triggered a hospital admission and a life threatening rare illness. She had one of those “one in a million” diagnoses that only a TV doctor character like House could solve. What ultimately saved her life was her primary care provider (PCP), a seasoned internist, who had provided her care for a number of years, recognized she was in trouble. He knew the best specialists in the community to call in for consultations while she was an inpatient and ultimately they made a diagnosis that saved her life. Had she been admitted through the ER without her PCP, she most likely would have been admitted multiple times with a few false starts before a cause of illness was found.

I have several other friends in recent years, all who were diagnosed with an early cancer during annual routine checkups with their primary care physician. Their personal physicians found their cancer early on and identified the best team players for cancer treatment, recovery and a survival plan within their communities. In an unexpected health crisis, having an established relationship with a primary care physician paves the way for better access to quality specialist care.

We all pray that a scary diagnosis is not in our future. If we are proactive, our efforts to exercise, reduce stress, get adequate rest and eat right work to prevent most life threatening diseases. In the event a serious illness or condition appears, our entry in the rabbit hole of our healthcare system is most often through our PCP. We also rely heavily on him or her to determine, order and interpret the necessary surveillance testing to catch potentially harmful disease early, so intervention and treatment can be accessed sooner than later.

Given how important your primary care doctor’s role is in your personal health, I thought it would be worth talking about how to find a great PCP. Sometimes we have someone we someone we don’t connect with very well or something changes like our health insurance plan, and we need to find a new provider. I personally had to go through this process a few weeks ago, and I found a gem of a new doctor through doing a little research online and talking to a few friends in the healthcare field.

In today’s world, I would search for someone current in primary care who has had at least ten years of clinical experience, is board certified and ideally has a clinical appointment teaching in a university setting or hospital training program. Physicians who supervise other physicians in training are usually current on the latest research, standards of care, and knowledgeable about your communities specialists. With ten years of experience or more, they have referred thousands of patients to specialists and have seen the results with specialist care. Quality specialists will send back a consultation as well as an test results letting the primary care physician know how their patient is progressing. After a few years in practice, a great PCP knows who are the best specialists in your community.

Your search for an ideal physician should start with your health insurance website as well as informally asking friends, a nurse, or doctor you know personally. Most nurses and physicians are very cautious about who they see for their own healthcare. When you search for a primary care doctor in your community through your health insurance preferred providers website, you have access to the name of the medical school, residency program they competed and year completed. This allows you to get a sense of how long they have been practicing since graduation as well as knowing if their training was near your community. In addition, most sites will let you know if they are board certified and in what speciality.

Once you have a list of potential candidates from your health insurance website, you can Google the physician name and town to bring up the physician on physician rating websites. Healthgrades.com and Vitals.com have patient surveys on most practicing physicians that let you know more about their patient’s perception of the office setting, bedside manner, accurate diagnosis, and expected waiting time in waiting room. These websites are relatively new so there may not be as much data as you would like yet, but that will improve. Once you have a short list of physician candidates, then you can call the office to make an appointment to interview the doctor. A big plus includes finding a physician with a nursing staff that communicates by email so you don’t have to wade through automated voice messages. An office that is using EMR (electronic medical records) will have the ability to send your records instantaneously to any referral physician avoiding long waits to be seen by a specialist.

When it’s time to meet your new physician, arrive a few minutes early to check out the front office and waiting area. It is always worth confirming with receptionist that the prospective doctor is on your health plan before that first visit. The savings in seeing a preferred provider within your health plan can translate into many dollars in a very short time. Look around, and notice if the space clean and organized. Does the office run smooth and efficient? When you interview a physician, most people know within 10 minutes or so if this is someone they could trust with their most valuable asset, their health.

I interviewed a specialist a few weeks ago a friend recommended for speciality care. My visit began with a nurse taking my complete medical history before seeing the physician. Very quickly I sensed she didn’t understand my answers, but she was plowing ahead to the next question on her forms anyway. After a very long wait, the physician entered the room and started the conversation with the statement, “We don’t need to go over your history because that is what my nurse does”. At that point, my first red flag went up.

When a physician takes a medical history, this is the first opportunity for the patient to articulate his or her story about why they are seeking care. The medical history is the basis of building a connection between the doctor and the patient. When a physician opts out of history taking with a new patient that doctor is signaling that building a lasting therapeutic relationship with the patient is not their priority. As we talked, more red flags appeared and I knew I had to keep looking for a different doctor. Listen to your gut instinct, and you will know when you find someone who is a good fit for you. Once it’s a go, sign a records release to transfer all of your old records to your new physician. This will give your new doctor access to all your previous records including vaccinations, testing results, problem lists and medication records.

Giving your new physician access to your past records will save you time and money in the long run. When your world is already transaction heavy, taking on a project to find a new physician may seem inconvenient but having a quality primary care physician overseeing your professional health needs is like having an added value insurance policy available whenever you need it.

I am available to set up an initial no charge consultation to discuss personal health coaching for anyone interested in upgrading their health through optimal health planning, goal setting and lifestyle changes. A health coach introductory package will be offered only if I believe a good fit for coaching exists. This time around I have added a new section on my website under About Your Coach tab http://healthcoachadvantage.com/about-the-coach that includes personal testimonials from some of my private health coaching clients as I celebrate the first year anniversary of my private health coaching practice.

Rethinking Wheat And Whole Grain Diets

06 March 2012 Janet Solie MS, PA, IHC

As an integrated health coach, and clinician, I have followed nutrition and food policy in the US for many years. Not only do I want to have the most current information and best diet strategies for my clients, I want to provide the healthiest and safest food for my family. I intentionally buy organic and make homemade meals for most dinners as well as having a plentiful selection of fresh fruits, nuts and vegetables for snacking at home. In the last few years, I have discovered simple changes in diet can improve health especially if you have struggled with obesity, allergies, asthma, fatigue, chronic pain, headaches, or gut symptoms including diarrhea, constipation and gastric reflux.

Growing up in the 60s, my mother worked for a grocery chain store bakery and we ate TV dinners, fried chicken, pizza, hamburger helper, and sugared wheat cereals like Wheaties and Frosted Shredded Wheat. Mom packed brown bag lunches with bologna Wonder bread sandwiches, a piece of fruit and a Ding Dong or Hostess cupcake. Dinner always ended with a selection of cupcakes, chocolate eclairs, pie or a slice of German chocolate cake for dessert. Looking back, most of the food I grew up with promoted cellular inflammation.

Of course in those days, we didn’t know cellular inflammation would lead to increased obesity, diabetes, cardiovascular diseases, autoimmune disease and cancer. The effects of that diet initially are transparent but eventually a diet based on wheat and laden with high fats, sugar, processed foods, and food additives, takes a toll on the human body. My generation grew up on convenience food. My parents were proud to be able to provide plentiful meals. They had no knowledge of the possible effect of consuming artificial ingredients, chemicals, herbicides and processed foods.

When I trained in medicine we learned about celiac disease as a disease of mal absorption. In a tiny group of patients, their intestines couldn’t tolerate the protein gluten that is in wheat, rye and barely. In all my years in practice, I never saw a single case of celiac disease presenting as someone who was malnourished. However I saw plenty of asthma, arthritis, diabetes, cardiovascular disease, obesity, auto-immune illness, gastrointestinal diseases, allergies and fatigue most of which occurred due to unexplained causes. Not knowing what was causing so much illness, we just focused on treating the illnesses with medicine and follow up visits.

We know now there is more to the story of wheat, the American diet and illness. I found the details of the real story of wheat in a new book called Wheat Belly by Dr. William Davis, MD, a cardiologist, that was recently published. Dr. Davis explains that the wheat we ate in the 1960s is not the wheat we eat today. Food science has genetically modified wheat to be compatible with specific fertilizers and pesticides in order to produce more grain. The wheat we eat today could not even grow in the wild. The original chromosome count of wheat has been modified from 28 to 42 chromosomes in order to produce bigger seed heads, shorter stalks and a shorter growing time. What I discovered in reading Wheat Belly is that wheat has been hybridized over the last 50 years without any testing to determine safety for human consumption in the quest to end world hunger. An additional concern is that wheat’s glycemic index (70 to 71) is higher than table sugar (60 to 65) . When you eat a slice of whole grain bread you get higher glucose levels and a bigger insulin response than eating a tablespoon of table sugar. No wonder we are a fatter population who feels tired much of the time.

The US government recommends whole grains as an essential food in a balanced daily diet. In truth, we are a nation a burdened with a growing obesity problem. As I ponder the government’s daily whole grain recommendations, I think back to my experience as a horse owner. Horse owners soon learn the fastest way to put weight on a horse is to add grain to its diet. It’s not rocket science. Farmers have known for years that to put weight on livestock, you grain them. So why as a nation with an epidemic of obesity are we are recommending a diet based on daily plate portions of whole grains?

I suspect that the big food corporations have a hand in current government dietary recommendations. Consider that corn and wheat are government subsidized to keep grain production cheap and profitable. Take a stroll down the interior aisles of your grocery store and look at the ingredients in a variety of food products, and you will discover most contain wheat and or corn as cheap fillers. Food manufacturers dress up the food products with whole grain high gluten containing flours and a few seeds. Then the food manufacturers claim it is heart healthy to eat.

Part of my coaching practice includes clients who are looking for better self- management in the areas of nutrition and weight control. In this area, my health coaching includes the essential strategies, successful goal setting, and individual support needed to implement diet changes. There is a sense making, and measured approach to eliminating gluten from one’s diet. With the correct preparation and mind set, a whole new experience of optimal health is available.

As for me, I celebrated a wheat free year in January of this year. The changes in how I feel have been revolutionary- more energy and mental clarity, less arthritis pain, less headaches, less cardiovascular risk and less gut symptoms. An added benefit from reducing consumption of all whole grains is that I find my personal weight management infinitely easier.

Looking Back To Go Forward

24 January 2012 Janet Solie MS, PA, IHC

As we start a new year, my coaching clients and I are reviewing their progress since they began a coaching program with me. Over the years, I have come to appreciate that progress unrecognized is progress lost. Even my clients who have been in coaching as little as three months have made impressive inroads in the areas of stress management, exercise, movement, rest and nutrition.

Coaching is first and foremost a transformative process where obstacles are on-ramps for new perspectives, a mindful experience that allows clients to move forward on their personal path to better health. All of my clients are caring, sensitive, thoughtful working professionals who have declared their personal health a priority. They understand that a large portion of their quality of life depends on the quality of their personal health.

We all have areas of our health that are challenging, that we can’t seem to improve on our own. This is why my clients decided to hire me as their integrative health coach. Like an athlete with a performance issue (i.e. a weak serve or a persistent slice), they have turned to me to help them improve their health game. Through lifestyle changes and self-care we explore new approaches to old challenges.Our goal is to collaborate to find a breakthrough.

For the next 30 days, I am offering an introductory three-month package(that includes two, one- hour coaching sessions each month for a total of six private coaching hours) for $250.00.In addition, this offer includes a Duke University Mindfulness CD to add to your tool kit for stress management and a subscription to Experience Life, one my personal favorite health coaching resources.

You can read more about my work at www.healthcoachadvantage.com.If you have any questions, please email me at janet@healthcoachadvantage.com.Also feel free to call or text me at 818 268 5531.As with all new clients, I will schedule a short free initial coaching session to discover if there is a good fit for coaching before you actually purchase a coaching package.

Killer Triad Dilemma

16 November 2011 Janet Solie MS, PA, IHC

In my family, both my father at age 63 and my only sibling a brother at age 48 were taken early due to a combination of coronary artery disease and diabetes. My father struggled with obesity and diabetes from his early 30s. Although he saw his family physician often for care related to his diabetes, high blood pressure and coronary artery disease, no one spent time in a coaching role to help him with the necessary diet and exercise changes that could have extended or improved his quality of life. My father took a multitude of medications for his heart and diabetes, but medications can’t cure diseases like coronary artery disease and diabetes. At best the meds attempt to control symptoms. If he had modified his diet, lost the extra pounds he carried for so many years and began a walking program, he most likely would have lived a longer life.

My brother who was a smoker and overweight by the time he hit his 40s, dropped dead of a heart attack getting ready for work one morning several years ago. An autopsy showed that he had extensive coronary artery disease and had unknowingly suffered a previous heart attack a year or two earlier. Although he rode his bike for errands in his neighborhood, he continued to smoke two packs a day for 30 years prior to his heart attack. The combination of his obesity and smoking slowly damaged his coronary artery circulation to the point his heart muscle was chronically starved of oxygen. Then one day abruptly without warning he was gone.

A few years after my father’s passing, my mother remarried only to experience with her second husband the third leg of the killer triad- Alzheimer’s. Seeing the illness develop and progress in my stepfather, it’s clear that this is a disease worth preventing. My stepfather is slowly disappearing.The disease has taken a huge emotional and physical toll on my 83 year-old mother who has become the caretaker for her husband. The medication for which he will take the rest of his life seems to help little for his diminishing short-term memory or his growing confusion over the simple tasks of daily living. Recent studies have shown a promising reduction in the incidence of Alzheimer’s for those who maintain a normal weight, exercise regularly and have normal blood sugars.

The big news about the diseases that attack the heart, brain and body parts is that the same lifestyle habits promote their development. My husband David refers to the trio of diseases that attack the heart, brain and body parts as the “killer triad”. If you visit any hospital, or a nursing home these days, the majority of patients are suffering from coronary artery disease (heart), Alzheimer’s (brain) or the effects of diabetes which attacks body parts (pancreas, eyes, kidneys, and lower extremities). As we age, we all fear loss of body parts, a debilitating heart attack or the loss of our memory and personhood. The fact that all three diseases are connected by diet, blood sugar, exercise and smoking cessation means that modifying lifestyle for one disease modifies the risk for all of these diseases. It makes a compelling argument to pick any point of intervention in lifestyle behaviors because you create opportunity to modify or prevent the killer triad.

Although the details of my personal family history are painful to review, it is important to share why I changed careers from being a health care provider to becoming an integrative health coach. Had health coaching been available, it could have made a difference in my family’s lives. The answer to preventing the majority of disease in our country is not as simple or as expensive as a trip to the pharmacy. The answers begin with simple but very challenging changes in diet, stress management, exercise and avoidance of cigarette smoke. The earlier lifestyle course corrections are implemented, the better outcomes are seen in quality of health. That being said, it’s never too late to implement smoking cessation, weight control measures, reduction in dietary sugar consumption and exercise and add quality years to your lifespan.

Because these changes are challenging and difficult to achieve for most, a health coach provides the skills and accountability necessary to guide you through the process to achieve the health related course corrections you want to make in your life. As always, you can email me if you have questions about how health coaching and how it could change your life.

In Hard Times, Making Things Last

13 September 2011 Janet Solie MS, PA, IHC

The other day I was at a patio store buying new covers for my patio furniture. The owner mentioned no one was buying new furniture anymore. Instead he said, “Customers were just buying new cushions and umbrellas. Of late, shoppers were looking to make what they already had last longer”. It occurred to me that health coaching could be framed the same way. We only have one body in this lifetime and we need to make the best health choices so we last longer and enjoy good health.

Health coaching is about using vision and values to set small goals toward optimal health. All along the way, we measure progress toward goals set by you the client. What I find when coaching women are that often times a conflict exists between professional life, family and personal health. The conflict arises around personal energy boundaries. Many women put their own health needs (working out, stress management and real food eating) secondary to the needs of their families or their jobs. Taking care of yourself first replenishes your energy stores so you have the energy to give your family and or career the time, problem solving and creativity skills demanded. Coaching women to set boundaries so they have the energy and time to dedicate to their own health goals is fundamental to success.

The secret to lasting good health is building a foundation for optimal health. Optimal health is about preserving function in the activities that are enjoyable. For women that activity could be as simple as putting on clothes that fit well because you are at a personal weight in which you feel and look good. Those good health functional activities could be gardening, playing with your kids, running a race, taking a yoga class or cooking a fine meal.

In medicine we often define optimal health by a report from the lab showing normal blood test results. This along with a normal physical exam is reassuring if you are a health care provider, but meaningless to the average person who defines their health by how they feel and look. In health coaching we focus on the client’s definition of optimal health and guide her to her vision through a series of client defined goals. As the coach I hold the client accountable to meeting the client’s goals between sessions. When goals are unmet, together we look at internal and external barriers and find a work around for each barrier.