Clinic Schedule changes for 2014

The clinic schedule for Callang General Hospital is now posted in Clinic Schedule page. We regret to announce that the Citimedic Medical Arts clinic in Tuguegarao will be closed until further notice. Patients from this clinic may choose to go to the Callang General Hospital clinic. We suggest that you TEXT us at least a week before the clinic schedule to verify the date (CELL 0918-933445).

We are pleased to inform you that we have added clinic hours on Tuesdays for our UST Hospital Clinic.

Too lazy (or too smart) for primary care: which one are you?

My first role model as a doctor was a retired military surgeon in general medical practice in my hometown. He had a ready laugh. To my childhood eyes, he was the smartest guy around. He makes me feel better when I am sick!

The Annals of Internal Medicine point-counterpoint articles tries to answer the question on how to increase medical student interest in primary care by looking at what gets them interested. What do you think?

Too smart

Too lazy

How do YOU keep up with the medical literature?

     I have tried many ways of keeping up. I remember when I was a medical resident I tried to keep up by printing everything that I can get my hands on and ended up with piles of reprints that are unread. That does NOT work.
     The use of the educational prescription came next. This is one sheet of paper where I am supposed to keep track of my clinical questions from the description of the problem of a specific patient to the resolution of the problem by review of a journal article. I started that a few times with medical trainees but it does NOT get done. I am still working on a self-assessment module from ABIM using the same technology, and, you know the drill, it is still NOT done.
     Reading the following blog post, I am attracted to the "headlines, tweets, and abstracts" approach that is described. http://www.kevinmd.com/blog/2013/10/medical-literature.html
     What is the best way to keep up with medical literature for ME? I guess it would be what works for me at this time. I read somewhere, on a different subject, that is like riding a bike - you will never know until you try. Try different ways to keep up - until you find what works for YOU!

Changing your lifestyle works (even in the elderly)!

When seeing an older patient, we often hesitate to advice them to adopt healthier health habits. We think it is difficult to change lifestyles is difficult (true!) and changing late in life may not change anything. Two studies on the association of healthy habits and mortality challenges this thinking. In both studies, those who had more of the healthy habits are less likely to die during follow-up.

The list of healthy habits are different but overlap. One lists regular exercise, healthy diet, smoking avoidance, and weight maintenance. The other lists a Mediterranean diet, moderate alcohol use, physical activity and nonsmoking status.

The bottomline is: those who have more healthy habits live longer.

http://www.ncbi.nlm.nih.gov/pubmed/15383513

http://www.ncbi.nlm.nih.gov/pubmed/23733562

Should peripheral IV sites be changed routinely? NO

Peripheral IV sites are changed routinely every 3 days in at least one of the hospitals where I practice. The results of the 2013 Update of a 2010 Cochrane review comparing clinically indicated change versus routine replacement of peripheral venoous catheter sites continue to challenge this practice. There was no  statistical difference in rates of suspected catheter-related bloodstream infections between the two methods of replacement. Neither was there a difference in phlebitis rates. In their conclusions, the authors recommend that peripheral venous sites be inspected every shift and changed only if there is one of the following signs: inflammation, infiltration or blockage.

http://www.ncbi.nlm.nih.gov/pubmed/23633346?dopt=Abstract

Re-imagining geriatrics: an interesting geriatric care model

I like this geriatrician's model for delivering geriatric care. It sounds like a win-win for her and her patients. I wonder how this could be adapted to the Philippine setting.

http://www.over65.thehastingscenter.org/reimagining-geriatrics/

Who are more handsome - surgeons or internists?

In Barcelona, surgeons are taller and more handsome than internists. The 6-year old journal article was brought to my attention reading another physician's blog. Here is the link:

http://www.bmj.com/content/333/7582/1291

Change in Clinic Schedule

Clinic days in Santiago are re-schedule from 5- and 7-October to 28- and 30-Sep. Please make a note of this. Thanks!

Time off for the doctor: is it good for patients?

     "Do you have clinics on Saturdays?" one of my patients asked me today. "No," I replied. "The company told me you had Saturday clinics," she countered. I had to explain to her that I did quite a few years back.

     This conversation made me think about why I no longer hold Saturday hours in my city clinics. I need to take time off to renew myself every week.

     I have been taking time off more or less regularly on an annual basis. I spend time in silence, prayer and deep conversation. This helps me renew in mind, body and spirit. This has become a habit such that I look forward to it when it is due, and I long for it when I am unable to do it at the usual time.

     My provincial clinic is a different story. Because I only go there a few days a month and my patients get agitated when I don't keep my scheduled days, I have been sticking strictly to my published dates. That is until this year. This April and May - when medical school is out - I have cut down my scheduled days.

     I wonder how my patients feel about their doctor taking time off - for weekends, for school breaks, and yearly. I hope they would agree that it is good for the doctor, and for them as well.
   

Doc, these are important to me!

Have you noticed that when making health care decisions, you can have as many choices as there are people involved? Use of the worksheet suggested in the following link may help facilitate such decisions. Read and fill it out to bring to your next appointment to your doctor.

http://thegeriatrician.blogspot.com/2011/08/communicating-to-physicians-goals-of.html?spref=fb

When more is NOT necessarily better for patients

Choosing Wisely, an initiative of the American Board of Internal Medicine, says NO. Here are the links for 5 tests or treatments (and the situations) that patients should question.

For adult patients (internal medicine)

For older adults (geriatric medicine)

For patients with arthritis and other rheumatic disease (rheumatology)

Always and forever: living with a chronic disease

I encounter two kinds of patients with arthritis: one comes to consult me just before leaving for a long trip and the other one comes to consult expecting to rest. The first response is perfect for those who are well and just want to be reassured they are well. The second response is also perfect for the flu or pneumonia: you get sick like a dog, rest, take your meds and then leave when you get better. These are NOT good responses when dealing with arthritis, the other rheumatic diseases I treat, and even diabetes.

Arthritis is a chronic illness for the most part. Once you get it, you have to live with it. You will have good days and bad days. We hope that most of them will be good. Taking your meds that the doctor prescribes helps increase your chances of having mostly good days. Medications can have side effects; they are not always good for you. This is where the follow-up clinic visits help.

During the follow-up clinic visits, your doctor should ask how you have been since you last saw her/him. How has your arthritis been? Have you been able to do your activities without difficulty? Have you been sick? Have you noticed anything new (or a worsening of something old)? Your answers to these questions help the doctor adjust your treatment, if necessary.

Living with a chronic disease is a case of always and forever. The disease stays with you but you can do something to keep yourself as healthy as possible.

Change of Clinic Schedule in Callang and Citimedic

The March clinic days are changed as follows: Callang Clinic from 2-Mar-2013 to 9-Mar-2013, and Citimedic Clinic from 4-Mar-2013 to 11-Mar-2013. This is in response to the scheduled annual Revalida for the UST Faculty of Medicine and Surgery.

February and March clinic days in Isabela and Tuguegarao

The next clinic days in Isabela are: 16-Feb and 2-Mar. Tuguegarao city will be on 4-Mar-2013.

Planning a clinic visit at Callang? Please note these.

In order to facilitate your follow-up visit at Callang with me, please note these procedures we have instituted.

For FOLLOW-UP visits,
1. Appointment numbers will be given in person by Misael on the day of the clinic as early as 700AM.
2. Patients given follow-up appointments for that clinic day will always be given a slot.
3. Early follow-up visits due to urgent concerns will likewise be given a slot.

For NEW patients,
1. We accept walk-ins up to the maximum number set for the day.
2. Appointment numbers will given by Misael on the day of the clinic visit.
3. You may choose to be seen on a different clinic by asking for an appointment for that day. Numbers will still be assigned on the day of the actual visit.

You may continue to TEXT 0918-9334458 to verify our clinic schedule in advance. Please allow up to the end of the working day for a reply.