27 February 2019 Blog Post: FIT “poop test”

27 February 2019 Blog Post: "FIT" or Immunochemical Test

Patients 45 years and older coming in for their annual examinations may have noticed an increased emphasis on colon and rectal cancer screening through the “FIT” or Fecal immunochemical test. This “poop test” or “poop kit” – FIT detects blood in your stool which can be a sign of pre-cancer.
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Generally in my discussions, I refer to it as an “adjunct” to colonoscopy which is our traditional gold standard for colon and rectal cancer screening. However, a new study suggests that FIT testing should no longer be considered an secondary testing strategy.
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A meta-analysis combining 31 published studies published this week in the Annals of Internal Medicine has shown outstanding performance of this test in the detection of colorectal cancer. FITs had a sensitivity (the ability of a test to correctly identify those with the disease) of 91%. Its specificity (the ability of the test to correctly identify those without the disease) ranged from 90% to 95%.
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An editorialist called for “better education to inform patients and physicians that regular screening with FITs is not a ‘second-best’ strategy or less than a ‘gold standard’ strategy for average-risk persons.”
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Consider this physician informed.

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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26 February 2019 Blog Post: Interesting Article

26 February 2019 Blog Post: Interesting Article

An interesting article published in JAMA Internal Medicine has shown that a higher number of primary care physicians per capita is associated with lower population mortality.
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Studying 142 US counties, 7144 primary care service areas, and 306 hospital referral regions from 2005 to 2015, researchers showed that each additional 10 primary care physicians per 100,000 population was associated with 52 days more in life expectancy.
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The addition of 10 specialists per 100,000 population was associated with a 19-day increase in life expectancy.
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Dr. Thomas Schwenk of NEJM Journal Watch General Medicine comments: “Many studies have shown a strong relationship between primary care access and better clinical outcomes at the country and state-level. Now we have confirmation of this relationship at the county-level. These results should influence health care policy decisions that support and enhance primary care as a way to improve health care outcomes.”

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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20 February 2019 Social Media Post: 5 P’s to take in case of Evacuation

20 February 2019 Blog Post: 5 P's to take in case of Evacuation

A patient reminded me yesterday of the “5 Ps” to take in case of an evacuation which, unfortunately for Southern California, has become more commonplace. So before evacuating remember:
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1. People and Pets (and other livestock if possible)
2. Papers (Important documents such as drivers license or passport, insurance, titles to property)
3. Prescriptions (Pills and eyeglasses)
4. Pictures (Irreplaceable memories)
5. Personal Computer
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If, in an evacuation or just in day to day life, you happen to forget prescription medications, remember that at Santa Monica Primary Care, we do all electronic prescribing and can send any prescription medications you may have forgotten to a nearby pharmacy.

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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16 February 2019 Blog Post: Flu Season

16 February 2019 Blog Post: Flu Season

Data published today by the CDC suggests that the flu season thus far has been ‘mild’.Compared with recent seasons, the current season has seen a lower percentage of outpatient visits for influenza-like illness, lower hospitalization rates, and fewer deaths due to pneumonia and influenza.
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Vaccine effectiveness has been 47% this season. For children, the vaccine has been 61% effective.
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Here Santa Monica Primary Care, we have seen more influenza cases in the past 7-10 days. This does not entirely fit with Columbia University’s prediction model which suggests that we have already past the peak of flu season here (the week of December 30th, 2018 had the highest number of reported cases and numbers have trended downwards since that time). Click the link below to view the chart.
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Flu usually comes on suddenly. People who are sick with flu often feel some or all of these symptoms:
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Fever* or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (tiredness)
Some people may have vomiting and diarrhea, though this is more common in children than adults.
*It’s important to note that not everyone with flu will have a fever.
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If you feel any of these symptoms, please do call us to make an appointment at 310.828.4411. We do have rapid flu testing available in the office.

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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10 February 2019 Blog Post: Medicare

10 February 2019 Blog Post: Medicare

I thought that some of our patients nearing Medicare enrollment age would be interested in the following exchange that I had with a Neurosurgical colleague who was bemoaning an extended authorization process for a CT scan on a patient with a Medicare Advantage plan.
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Dr. Gantwerker posted: “To any of you reaching Medicare age: Do not, under any circumstances, sign up for a β€œMedicare Advantage” plan. It is an hmo by any other name. If you are able to, stay on Medicare with a supplement. Medicare is and remains the best insurance out there. The advantage plan only throws roadblocks In the way of your doctors ordering completely appropriate tests. I just spent an hour on the phone arguing with somebody about why a patient with an upper cervical spine fracture need another CT scan. This is not a time Or money saver. What it is is strictly a money saver for the paper pushing people whose job it is to get you less quality physicians and care.”
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To which I replied: “Brian R. Gantwerker, this is an excellent point. To add on, I find that the selection of a supplemental plan becomes an issue that Medicare replacement plans exploit when marketing (and, yes, it is marketing) to patients. Medicare covers 80% of incurred costs and the remaining 20% (sometimes called “Medigap”) is then covered by a supplemental plan which needs to be purchased and paid for by the patient. Selecting an affordable supplemental plan does not need to be a frightening proposition. I typically direct my patients to the AARP website who has an excellent tool to help choose one (www.aarp.org). Also, AARP itself offers a plan administered through UnitedHealthcare but on their site they strike a good balance between promoting such and encouraging patients to be savvy consumers. AARP is a great place to start looking (they can even save you on an Amazon Prime Membership!). Many of my patients have supplemental plans through USAA, Mutual of Omaha, and Blue Cross/Blue Shield among others. Patients have worked their entire life to be able to utilize their Medicare plan and it seems hasty to simply sign it away without careful analysis or research. Medicare.gov also provides an excellent tool so patients can understand their true cost, enabling an informed (rather than advertising or fear driven) decision.”
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Dr. Gantwerker replied: “I agree, Phil. My parents were/are members and have had the best coverage throught the UHC suppplement AND hospital indemnity insurance and that has been priceless! Thank you for the tool you shared.”

𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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