Category Archives: Opinion

DR. C’S JOURNAL: THE RISE OF ‘CONCIERGE MEDICINE’

I am a physician. I believe that the modern medical care system is broken. It used to be that the patient selected the doctor because of her reputation, and the doctor was motivated for excellence. Now the doctor is apportioned by the insurance system, and the doctor is motivated to be “efficient” (to see more people in less time). 

Coupled with electronics surveillance of doctors, requirement for electronic medical records, the expansion of patients in a doctors practice to quadruple the number it used to be, plus increasingly technological surgery ( I consider search doctors as technicians more than physicians ), a system of payment that favors such surgery,

With the “disease” model of medicine still dominant over the “health” model, it is difficult for the doctor to take patient’s phone calls, inform patients of their laboratory results, counsel them in nutrition,  exercise, sleep, and other health benefits, or even see them the same day as their illness. Thus “go to the emergency room“ is the default advice.

The concierge doctor attempts to remedy some or or most of these deficiencies, which characterize the usual modern medical practice. Concierge medicine  is so different from regular medicine as to draw the interest of Congress in preventing such discriminatory behavior.

Of course, the concierge doctor charges a periodic fee to deliver these services; there in lies it’s “unfairness”. I have even heard of super concierge doctors who meet your injured child at the emergency room with the chief of orthopedics , or fly with you to the Sloan Kettering Institute if you need consultation there. They, of course, charge tens of thousands of dollars annually for such service.

We already have multiple tier medical systems in America. The original concierge Idea modeled the care delivered to professional athletes, who must stay healthy in order to play.

Of course, there are still good doctors out there if you look hard enough and are lucky. Some family practitioners and internists still manage to practice quality medicine. Otherwise, my advice is to find a concierge doctor you can afford.

–Dr. C

Doctor’s Journal: ‘Alcohol And Health’

Alcohol has been used by mankind since before recorded history. It causes a pleasant slowdown of the nervous system, Lessening inhibition  and loosening the tongue, making it the perfect lubricant for social interaction. Unfortunately, it is a metabolic poison.

Excess alcohol use is common enough to have resulted in its prohibition in the United States in the 20s. The side effects of this prohibition proved worse than its benefits, and alcohol currently enjoys the status of one of the few legally permitted Psychoactive drugs.

After diligently searching for beneficial effects of alcohol, society discovered that mild drinking promotes longevity. It is difficult to drink just the right amount of alcohol, and  There is little doubt that excessive drinking is deleterious to the body.

The liver is the organ responsible for getting rid of alcohol. Unfortunately, liver function gradually declines with age, so that the older you get the less alcohol you can tolerate. 14 drinks a week is the suggested upper limits for alcohol’s benefit, and this number shrinks as you get older.

I became interested in alcohol in the elderly because of a friend whose doctor discovered that his red blood cells were enlarged. This can be due to alcohol in at least two different ways. If you drink too much alcohol, you need less calories, and often have a poor diet as a result. B12 (and folic acid) deficiency can result and may cause large red blood cells.

I also learned that alcohol can directly caused large red blood cells because of the toxic effects on the bone marrow, where Red blood cells are made. The very young also have more difficulty with alcohol. Early in my career I discovered 2 young infants who had convulsions after getting into their parents wine closets. These convulsions turned out to be caused by a low blood sugar which developed because glucose, the common blood sugar, is consumed in the process of burning, or metabolizing, alcohol.

My own use of alcohol has been progressively declining with age. I feel good with less alcohol for a shorter time the older I get.

—Dr. C.

Bladder Cancer: Causes, Symptoms & Treatments

Bladder cancer is the fourth most common cancer in men, after prostate, lung, and colorectal cancer. A man has about one chance in 27 of getting bladder cancer during his life time. It is less common in women.

The urinary bladder is exposed, through the urine, to the waste products of the body. Cigarette smoking is the most common risk factor, and I suspect a lot of the chemicals that are in our environment could be suspected, like the delicious smoky flavor of  barbecued food.

Bladder cancer does not often run in families, but it seems to in mine. My father died of bladder cancer, and I have just been diagnosed with it. When it runs in families, FGFR 2 can sometimes be found in the genes.

Hematuria is the most common Presenting symptom, but there are few  other marker symptoms that give Bladder cancer away; It has been called it “the silent killer”.

Cystoscopy Is the most sensitive test for bladder cancer, and  is not a painful examination in the hands of a good urologist.

In my opinion, cystoscopy should be used as  a reasonable screening test to pick up bladder cancer at an early stage, when it is more treatable.

–Dr. C

Read article from Mayo Clinic