Despite  or at least in exception to  the  link below, I suggest the following:

1.It is worthwhile to measure Vitamin D levels in adults.

2.It is reasonable and safe to supplement with Vitamin D3 to serum levels of 40-70 nanograms per ml.

3.Some individuals require much more vitamin D3 than others to acheive these levels.  Old recommendations of 400 international units/daily are often not adequate. Over the counter vitamin D3 capsules are available in 2000 to 4000 IU sizes. There is also a long acting prescription version of vitamin D3 containing 50,000 IU’s; this is taken periodically.

4. Evidence is evolving in the medical literature for various benefits of adequate vitamin D,  including improvement in arthitis, bone density, circulatory problems, cancer prevention, memory/cognitive function  and many other areas of interest.

So when you come in for a check up, let’s talk more about vitamin D.

http://www.nytimes.com/2010/02/02/health/02well.html?scp=1&sq=vitamin%20d&st=cse

http://www.healthcareitnews.com/news/new-medical-model-it-could-improve-patient-care-family-practices

Does the attached article represent the future of primary care? 

Will it work?  

Is restructuring to this model of care possible ? 

http://managedhealthcareexecutive.modernmedicine.com/mhe/Thought+Leadership/Unlocking-Primary-Care-CareOregons-Medical-Home-Mo/ArticleStandard/Article/detail/595822?searchString=unlocking%20primary%20care

ARE GENERICS SAFE?  Although one of the larger domestic generic drug producers is located locally( TEVA Pharmaceuticals, formerly Barr Labs), more and more generic manufacturing is being done overseas.  Without question this has caused some quality control concerns for certain drugs, because the FDA is not able  monitor production as effectively overseas. What seems to happen now is that problems with generic medications are sometimes identified after these drugs are in the marketplace, leading to recalls until the problem is corrected. Considering the volume of generic medications in use today this does not happen often, but when it does, patient health is at risk. We are very concerned about this issue and do everything possible to steer our patients away from generic medications that are of concern. The reality of today’s medical practice is that almost all generic medications are safe, effective and much less expensive than brand name alternatives; we will prescribe generic medications in the best interest of our patients when we believe it is safe to do so. If our patients want only a brand name medication and accept the additional cost, we’ll certainly prescribe the brand name.

GENERICS AND INSURANCE COVERAGE. Most pharmacies now offer certain generic medications at a very low set rate. Walmart began this trend with its $4 per month generic medication list; CVS, Walgreen’s, Target and Kmart all do essentially the same thing. Frequently the price for these selected generic medications is so low that it is cheaper for an individual to pay for the medication out-of-pocket than to use their pharmacy insurance coverage. In essence, the patient co-pay is more than the cash cost of the medication. Remember that not all generic medications are available at such low prices, but when they are, it pays to shop around and to ask the pharmacy which option is cheaper.   

We will be happy to discuss any concerns you may have about generic medications.  Good doctor-patient communication means  better health care.

Now comes the exciting discovery that a previously unknown viral infection may be the cause Chronic Fatigue Syndrome. Could there soon be a vaccine or antiviral drug that will help us prevent and/or treat Chronic Fatigue Syndrome? 

For more information:

http://www.nytimes.com/2009/10/13/health/13fatigue.html?ref=health

http://www.nytimes.com/2009/10/15/your-money/15CARE.html?_r=1&ref=health

http://www.nytimes.com/2009/10/15/your-money/15HEALTH.html?ref=health

 Mr. Alan Wise, Executive Chairman of the Board of Directors

Coventry Health Care, Inc

6705 Rockbridge Drive, Suite 900

Bethesda MD  20817

 Dear Mr. Wise: 

     I am a family physician providing health care services to a patient covered under Southern Health Services, Inc., a subsidiary of Coventry Health Care. Quite frankly, I am angry with you and your company and would like to express this to you directly.    

My patient is a 90 year old woman who has been housed at a local nursing home for many months. She is dying from widespread cancer, dementia and a number of other medical problems. I see her periodically at the nursing home as her condition warrants, usually several times a month. She has primary health insurance coverage through Medicare and secondary insurance coverage through Southern Health.

     Today my office manager informed me that several claims for my visits to the nursing home were denied because preauthorization was not obtained from Southern Health. Finally, after more than an hour of the usual telephone battles, she was told that I would not have to obtain prior authorization for each future visit, but would be “granted” up to eight more visits for the remainder of the year.

    I have practiced medicine for more than 30 years. I have navigated through generations of bureaucracy in a continuing effort to be a patient advocate. I thought I had seen it all, but never before have I been told I needed preauthorization to help my patient die.

     It seems to me that you, Southern Health/Coventry Health Care and the health insurance industry are reckless and out of control. You and your industry do not provide good service to my patients for the price you charge; you are all too often an obstacle in the path of their health care. I’m tired of wasting time arguing with unskilled insurance clerks and uniformed medical directors to defend the medical decisions I have been trained to make. You, and not I, should be accused of malpractice.

     There are many other problems with American health care. But our health system and our country cannot afford to let the insurance industry, in the name of “utilization review”, imprison those of us who provide healthcare in the current razor wire of claims and utilization mismanagement. It’s time for executives like you to look within, or you will surely be forced to change by outside forces. 

 Sincerely yours,

 David M. Smith, M.D.

In the last year several studies in Denmark and Canada have begun to question the value of mammography in preventing deaths from breast cancer, especially in women under the age of 50.  Experts arguing over scientific conclusions……. of course!     Sensationalized over the Internet…….of course!

In addition, despite minimal radiation exposure with modern mammography equipment (less than a chest x-ray, less than an hour on the beach in the middle of the day),  arguments continue about the safety of mammography. There are some other methods of testing for breast cancer ( breast MRI and breast ultrasound) that may or not offer advantages over traditional mammography. And there is a variation of mammography called digital mammography that may provide more accurate testing.

At present, the American Cancer Society http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=5   and the National Cancer Institute http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms    continue to strongly support regular  screening mammography for all women beginning at age 40 as the best way to detect  breast cancer.  Women with a family history of breast cancer  or other risk factors may begin screening earlier than this.

We support this approach to breast cancer diagnosis and will continue to do so unless there is further information to the contrary. We continue to believe that screening mammography should be optional for women over the age of 75. 

We also believe that the choice for medical care of any kind is a negotiation between the patient and their physician, a negotiation in which the patient, armed with the best information possible, has the right to make the final decision about what to do. Let’s keep it that way.

One more patient information link about breast cancer diagnosis from breast cancer.org http://www.breastcancer.org/symptoms/testing/types/mammograms/benefits_risks.jsp

http://www.aocd.org/skin/dermatologic_diseases/poison_ivy_dermati.html

 So how can we arrange for medical information to be exchanged between physicians and other health care providers when needed, without opening the door to unauthorized access or worse? Some aspects of electronic medical record keeping are beyond a practitioner’s control, but there are steps physicians can take to minimize the likelihood of inappropriate disclosure.

You might like to know that:

Physician’s electronic medical records can be housed on a server owned by the practice or on another company’s server, such as the electronic medical record vendor or some other outside organization. Although security systems are supposed to be in place, the further the data resides from the control of the medical practice, the greater the opportunity for there to be a security breach. Our practice has used our own server for electronic medical records for 10 years, for just this reason.

 The American Medical Association offers physicians the opportunity to specify whether or not their prescription information is made available to pharmaceutical companies. The last decade has seen waves of pharmaceutical representatives coming to physician offices to promote use of their products, leaving medication samples and other advertising. Pharmaceutical companies have used prescription information to focus their sales tactics to physicians. Imagine a pharmaceutical company being able to track how many prescriptions a physician generates for their product, compared to the competition! Our office chose to use the AMA option to block this kind of information getting to the pharmaceutical companies. We hope this continues to work.

 Some physicians in our community have a secure link to the Centra Health electronic medical record system. We can and often do look up information about your lab tests, emergency department visits, hospitalizations or radiology tests done at Centra. Centra limits access only to physicians who are caring for the patient. This system has been in place for a few years and has been very successful; it has been a major advance in better coordinating your health care. Please note that our office medical records are not available to the Centra system unless we release the information.