Dr. Iliff’s 2007 Practice Newsletter
Thanks for making us your choice for primary medical care. As we enter our 21st year of practice, it remains a privilege and a joy to serve you. And when I say “we,” I also mean Jackie Howard RN (also in her 21st year), 2005 Kansas Physician Assistant of the Year Scott Ford (20th year) and Diane Gordy RN (14th year). Our goal is to get better, not just older.
Points of Emphasis for 2007:
- Immunizations: Every patient who comes in for a Database Physical will be reviewed for immunization status. There have been a lot of new vaccines the past few years, and we’ll make sure nothing falls through the cracks.
- Preventive Care: Every time I read how many people have undiagnosed high blood pressure, cholesterol, or blood sugar in this country, I am amazed. Our goal is zero tolerance for these problems. There’s also no excuse for anyone dying young from a number of cancers. Which brings us to
- Database Physicals: As most of you know by now, I think the “annual physical” is a waste of your time and money. We make our Database Physicals a big deal over 2 visits, but only once every 2 years from age 50 up, and every 5 years below 50. Our recent survey showed that 46% of our patients are up to date, and 33% have never had even one. I would call the latter one-third accidents waiting to happen, but it wouldn’t be an accident. It’s willful ignorance. Wives: you’ll have to book the appointment for him. Men are instinctive deniers when it comes to health care.
Generic prescriptions: You hardly ever read about good news in pharmaceuticals, but the truth is that I can manage most major public health problems-- including hypertension, diabetes, cholesterol, gastroesophageal reflux, depression, and arthritis-- using excellent generic medicine costing $4 per month. Don’t just plunk down your insurance copay for generics. It may cost less to pay cash.
Penile Enhancement: Sorry, guys. You’re still wasting your money. Lose weight and it will look prouder.
The 14-Minute Mile: At least once a year, every one of you gets a reading on your blood pressure and body fat percentage. Now I’m going to add a measure of fitness, but for this one I need your help. Go to a local track, or a route in your neighborhood (measure with your car odometer, or do it online at walkjogrun.net), and see how long it takes you to walk a mile at a comfortably brisk pace. If you can do it in 14 minutes or less, you’re in great shape. If not, you are at a much higher risk of all-cause mortality (not just heart disease) than you need to be. If you’ve had your physical, go to the Family Practice section of my website and click on METs and Me toward the bottom; the Cooper Clinic walking program for couch potatoes is at the end. And take your kids on a hike.
What You Need From a Medical Office: To be seen within 24 hours any time you want, and to get a real person on the phone when you call after hours.
What You Want From a Physician (whether you know it or not): Good Judgment. This comes from really listening to your problem, helping you sort out opinions you have received from other physicians, TV ads, internet surfing, Cosmopolitan, and well-meaning relatives-- then coming up with a plan of action that best fits your personality, needs, and finances. You can’t get that for yourself, picking information a la carte from the smorgasbord of sources you meet every day.
What I Want From a Patient: For you to want to be playing softball, reading the newspaper, climbing two flights of stairs, chopping wood, and walking through Disney World with your great-grandchildren-- when you are 82. Then I want you to do the things you need to do at 37, or 58, to make that desire a reality. You can do it. I can help.
Don’t Ask Dr. Gott: Anyone else think the man has gone off the deep end with goofy remedies mailed in by patients?
Internet Information: Although I’m leaving trustworthy recommendations on my website, Google searches for medical information have gotten so good that I usually start there.
Gastroesophageal Reflux Disease (GERD) has become an epidemic in America, and despite effective medicine for symptom relief, we’re seeing an increase in esophageal cancer. Go to the Family Practice area of the website (near the newsletters) for my new approach to management.
Diet Programs That Really Work do not exist. They’re largely a waste of money, including the expensive diet clinics. A year or two later, almost everybody has gained the weight back. Here’s the only thing that makes sense: either eat less of what you like, learning to control your portions with the help of a dietician or Weight Watchers, or don’t bother. The problem with “diets” is that you are saying to yourself the whole time “I can’t wait until I can eat normally again.” And eating “normally” what got you fat in the first place
Meals on Wheels: My wife and I will be making home visits again in 2007 for babies I have delivered. This may be the most fun I’ve had as a doctor. My big concern regarding pregnancy is the rising C-section rate. Part of the problem is that we can’t do VBACs in Topeka, but I’m convinced that another factor is the trend away from natural childbirth. Ask me about it. There are things we can do to keep you out of the operating room.
Avoiding Infectious Disease: This is the time of year when I get lots of questions about ducking infections. Handwashing is of limited usefulness, because most germs are airborne. We ought to wear masks, like the Orientals do; but all your friends would think you have tuberculosis, and you wouldn’t get invited to holiday parties. Best bet: avoid the malls and movie theaters and go to early church service; take a daily fresh air walk; get plenty of rest; and drink fluids. Just like Mom said.
What’s New in Birth Control? We’re not using progesterone-only methods (Depo-Provera, Micronor, etc.) for more than 5 years due to osteoporosis. Evidence is accumulating that the 350-400 periods experienced by modern women (more than double that of our ancestors) may be linked to breast cancer and ovarian cancer. So why is birth control set on a 4-week cycle? The Italian who invented the pill was trying to please the Pope (it didn’t work). Women think periods “cleanse” the uterus. They don’t. Now prescriptions are showing up with 3-month cycles, but they are ridiculously expensive. I’ve been prescribing cheap generics 84 days on, 7 days off. If that sounds good, ask about it at your next visit.
Hormone Replacement in Menopause: It's hard to get good information from the media on this subject. There is lots of medical evidence indicating that the use of hormones in the first five years of menopause has great benefits for the circulatory system. What you are reading about cancer and strokes does not apply to the way I recommend hormone replacement.
Bang for Your Buck: When you come to see me, plan ahead. I want to solve as many problems as possible in one visit; that’s the advantage of a family physician. Make a list, and make sure the receptionist knows when you call for an appointment that you have 6 issues to talk about.
The Downside: When you make an appointment, budget at least an hour. I heard of a local doctor who allowed patients one problem per visit; 4 problems, 4 appointments. With that policy, I could stay on time. But you wouldn’t like it.
SpringForward 2007 will be early this year, because I’m taking my youngest son to Ireland over spring break. It will be Saturday, March 3rd, at the Iliff Commons. There will be a 5K run, a 5K METsWalk, a jog with your dog, and a mountain bike race. Check the website for details. All profits go to the Marian Clinic.