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September: A New Light on the Mall!
Amidst the bombings, shootings, and negative political palaver of September came a strong positive that captures the awesome Spirit of Our Nation: the opening of the National Museum of African American History and Culture, the 19th of the Smithsonian Institution's grand museums. I have yet to visit but I was uplifted by comments made by our leaders, past and present, at the dedication ceremony as reported in the New York Times on September 25. They spoke of the struggle for freedom and the sufferings of the giants upon whose shoulders we stand today. Former president Bush, who signed the legislation that funded the museum said, "This museum tells the truth that a country founded on the principles of liberty held thousands in chains....Even today the journey towards justice is not complete. But this museum will inspire us to go farther and get there faster." President Obama said: "We walk away that much more in love with this country...the only place on earth where this story could have unfolded." Ahhh, I feel better now!
John A. Schmidt, MD
Internist
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Colon Cancer Screening in the Elderly (seventy is the new sixty!)
How many times have I heard my 70+ year old patients say, "Oh, I'm too old for a colonoscopy." Now comes a study published in the September 27 issue of the Annals of Internal Medicine, based on Medicare data, suggesting that there is a benefit to performing colonoscopy in patients aged 70-79. If you are one of those 70+ year old individuals who has decided not to have a colonoscopy, ask yourself the following questions: Have you ever had a colonoscopy? If yes, how long has it been? Did you have polyps? Are you otherwise healthy? In general, those who have never had a colonoscopy or haven't had a colonoscopy in five years, had one or more polyps, and enjoy generally good health, should seriously consider having a colonoscopy. As reported by the CDC, the risk of colorectal cancer, as is true of most cancers, goes up with age. 70+ year old persons have the highest risk of developing colon cancer.
Medicare reimburses for screening colonoscopy without an upper age limit. Traditional Medicare and Medicare Advantage (as of June 15th) also cover the stool test known as Cologuard® once every three years for persons between 50 and 85 years old. Symptomatic patients, patients who have had polyps on previous colonoscopies, and patients with a family history of colon cancer are not covered. They must have a colonoscopy or pay for Cologuard® out of pocket ($649).
FIT® (fecal immunochemical test) is a stool test for blood/globin that you can perform at home for $24.99. Performing the FIT® annually in the "off-years" between colonoscopies or Cologuard's may speed early detection. However, bleeding due to other causes (e.g., bleeding hemorrhoids) will give a false positive test result. Cologuard® avoids this pitfall.
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Do You Have Major Mobility Disability (MMD)?
As reported in the September 27 issue of the Annals of Internal Medicine, Major Mobility Disability is defined as the inability to walk 400 meters (about five city blocks) in 15 minutes without a walker. In 2004, those with mobility disability were estimated to contribute more than $42 billion in additional health care costs and more than 2 million additional hospitalizations!
The good news is that, unlike so many other chronic conditions you and I deal with, MMD is preventable and often reversible. Sedentary lifestyles lead to MMD while active lifestyles reverse or prevent it.
The successful intervention reported in the Annals article consisted of walking 150 minutes (2.5 hours) a week and daily strength, endurance, flexibility and balance training either in the home or in a supervised environment. To see practical examples of how to improve in these four key areas, visit Go4Life at the National Institute on Aging. Those who participated in this program were more likely to recover from and avoid MMD.
Silver Sneakers
®
is an example of a commercial strength/endurance/flexibility/balance program designed to help seniors. There are many locations in the greater Belmar area that offer this program with or without a doctor's prescription. Insurance plans increasingly cover the cost. Call yours today.
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Hospitalists and the Decline of Comprehensive Care
As described in an editorial in the September 15 issue of the New England Journal of Medicine, one of the more disturbing trends in medicine has been the rise of physicians whose only responsibility is to care for you when you are hospitalized. Such doctors are called "hospitalists." More and more primary care physicians are choosing to focus on their office practices, entrusting their hospitalized patients to physician-strangers who work 8-12 hour shifts. The author concludes, "The true core of good medicine is not an institution but a relationship between two human beings and the better those two human beings know one another, the greater the potential that their relationship will prove effective and fulfilling for both. Models of medicine that ensconce physicians more deeply in spatial and temporal silos only make the prospects for such relationships dimmer." In other words, continuity of care, the key to preserving your health, is disrupted when your primary care doctor passes the baton, just when you are sickest, to a doctor who knows little about you, your medicines, and your medical history.
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Rethinking the Primary Care Workforce - An Expanded Role for Nurses
An editorial with the same title, also published in the September 15 issue of the New England Journal of Medicine, describes how nurses, including Certified Physician Assistants (PA-C's), Nurse Practitioners (NP's), and registered nurses (RN's) are playing an increasingly important role in primary care. As the author points out, "The size of the primary care physician workforce will decline even as the U.S. population grows, ages, and becomes more adequately insured." In contrast, the number of NP's and PA-C's is rising dramatically. Studies indicate that patient satisfaction and quality of care are similar for physicians and NP's in the primary care setting.
If you read the section above, you might be inclined to say that PA-C's and NP's, like physician-hospitalists, are disrupting continuity of care. On the contrary. Why? Because physicians, PA-C's, and NP's work as a team with equal access to your electronic health record (EHR). Encounters with the PA-C or NP are reviewed by the supervising physician leading to a discussion that serves to improve the quality and continuity of your care. In my practice, Valerie Richardson, Monica Clark, PA-C, and I work together to provide you with comprehensive care in the office, hospital, rehabilitation facility, nursing home, assisted living facility, and, if need be, your private home with remote access to your EHR in all of these settings. In this way, we avoid having to entrust your care to strangers.
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Medicare Open Enrollment
Medicare open enrollment is from October 15 to December 7. Please visit Medicare.gov to find an economical part D plan for your medications.
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Now Hear This!
The renovation of our new office space on the corner of Church Street and Route 71 in Spring Lake Heights (across from Hoffman's Ice Cream and Yogurt) is well underway and will be completed in plenty of time for our grand opening on January 2, 2017!! To better serve you, our office hours will be expanded. Picture postcards will be mailed to your home address in early December so please make sure we have your correct contact information!
September 26 came and went without the birth of our
third grandchild. The suspense!!!!!!!!!
Valerie, Ms. Clark, and I wish you an autumn filled with vivid colors, purple sunsets, and toasted marshmallows!
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Board Certified Internist
Dr. Schmidt is one of the leading internists in Monmouth County offering
Medical Home
services.
He is an Associate Attending in the Department of Medicine, Jersey Shore University Medical Center, and Clinical Assistant Professor in the Department of Medicine, Rutgers Robert Wood Johnson Medical School.
Dr. Schmidt is enrolled in the Maintenance of Certification Program of the American Board of Internal Medicine
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"By all these lovely tokens September days are here, With summer's best of weather And autumn's best of cheer."
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