Sunday, February 20, 2011

Of All A Physician's Roles, The Most Important Is That Of Educator

Clinician. Diagnostician. Prognostician. Healer.

A physician has many jobs to perform, all critical to the appropriate management of what ails our patients. Without astute physical exam skills or a keen ability to sort through a medical history to uncover salient data, the physician is no better at diagnosing a patient than a Google search (and we're quite a lot better, in case anyone was wondering). Without a proper understanding of physiology and pharmacology, the physician is no better at healing than a placebo, and might actually do harm!

As patients, we rightfully base our assessments of our physicians' competence on their ability to (as quickly and non-invasively as possible) determine what's wrong, and what to do about it. Unfortunately, we have also come to view physicians as the barrier to care, rather than the source of care. Who stands between the sick patient and the antibiotic? Whose signature is required before the blood test can be performed?

The fundamental problem with this perception is that it equates the technical work-up and the treatment with "care". However, "Take two of these and call me in the morning" isn't real health care, even if the tablets dispensed are indeed "just what the doctor ordered".

I would argue that the value taken away from a visit with your physician isn't in what you have been prescribed, but rather in what you have been taught. At the end of the day, the physician role most essential to fostering a trusting physician-patient relationship is that of Educator.

As an allergist/immunologist, the majority of the care I provide is for chronic illness, such as asthma, food allergy and immunodeficiency. These are conditions my patients need to deal with on a regular basis, day in and day out. There is no magic pill I can prescribe to cure them - no miracle treatment. The most important thing I can do is spend the time to teach them about their physiology, how the medicines I am prescribing work, or why I suggest a particular treatment over another. I can draw pictures, demonstrate the proper use of inhalers and injections, or review an action plan for a severe allergic reaction. Whether the topic at hand is skin care, allergen avoidance or dietary management, there are always opportunities for new education or reinforcement of existing skills.

Quality patient education is a mutually rewarding exercise: 1) the patient gains a more complete understanding of what is going on within his/her own body and has more insight into the rationale behind the physician's recommendations, and 2) the physician builds confidence and trust with the patient and dramatically improves the likelihood of compliance with recommended therapy. This has direct consequences for improved health. It is truly a win-win.

As the continual pressures on physicians to cut costs and optimize efficiency increase, we must resist the push towards gaining these efficiencies at the cost of spending less and less time with our patients. Although it takes a significant investment of time and effort to make patient education a cornerstone of a medical practice, the dividends paid are truly "healthy".

"The most important role of a physician is that of an educator. I believe in empowering patients to optimize health by teaching them to understand how their bodies work."

Saturday, February 19, 2011

I'll Keep Lying To My Kids, Until They Wisen Up

Horrible, isn't it? I feel no guilt whatsoever about the following dishonest charade...

Setting: Trusty Honda Civic, en route to a casual dinner out with the family.

Son #1: I want to go to Red Lobster!

Son #2: Red Lobster! Red Lobster!

DH: (whispering to me) Not tonight. I'll spend the whole time shelling crab legs for him. I just want a relaxing meal.

Allergist Mommy: Okay, kiddo. Let me call the restaurant...

(fake dials phone, lifts to ear) "Hello, Red Lobster? Do you have a table for 4? Yes, for tonight. Oh, really? Well, how soon will a table be open? 11pm?!?! No no, that's too late. Maybe some other time. Thank you. bye."

Honey, they are too full right now. How about Mexican?

Son #1: Okay, Mommy. I like their chips!

DH: Awesome.

This trick will only work for another couple of years. Until then, I intend to milk it dry.

Thursday, February 3, 2011

Sublingual Immunotherapy: Allergy “Drops” Can Offer Relief, Without the Sting of a Shot!

For nearly a century, doctors have known that the best way to control environmental allergy symptoms is by retraining your immune system to tolerate substances that you are currently over-reacting to. This is known as “immunotherapy”. 

Until recently, immunotherapy required multiple small injections over a period of time (subcutaneous immunotherapy). Although allergy injection treatment is very safe and effective, weekly trips to the doctor for shots are not always convenient for today’s busy families. This means that many patients are not able to take advantage of allergen immunotherapy’s numerous health benefits, such as decreased need for medications, improved hay fever and asthma control, prevention of asthma in high-risk children, and a better night’s sleep.

Sublingual immunotherapy, or allergy drops, can offer the benefits of immunotherapy to a wider array of patients. These drops are made from the same FDA-approved allergen extracts used in allergy injection treatments. Sublingual immunotherapy is the most commonly prescribed form of immunotherapy in Europe, and has helped patients manage pollen, animal, mold, and dust mite allergies. Because allergy drops have a very low rate of allergic reactions, they are considered safe enough to give in the home setting. Imagine, reversing your allergies in the comfort and convenience of your own home!

Here’s how the process works: after determination of your environmental sensitivities in the office, your allergist creates a customized set of allergy drops for you or your child to self-administer under the tongue, on a daily basis. Over the course of a few weeks, your dose will gradually increase to what is known as a “maintenance” dose. This is the daily dose required to fully retrain your immune system, so that it no longer produces allergic reactions in response to allergen exposure. Based on extensive experience with allergy injection therapy, a full course of immunotherapy usually takes 3-5 years, after which you can expect to continue the benefits for up to another 10 years after discontinuation. Investigations are still underway to determine if this sustained period of symptom improvement after stopping therapy also applies to allergy "drops", but preliminary studies suggest that it may.

You should know that sublingual immunotherapy is considered an "off-label" use of an FDA-approved product - this means that some health insurance plans may not reimburse for the costs of treatment. Generally, flexible spending accounts and health savings accounts can be used to pay for sublingual immunotherapy. Like all medical therapies, allergy drops are not suitable for every patient. There is evidence that allergy drops work very well for patients with a few specific allergies, but allergy injections work better for patients with multiple environmental allergies.  In addition, only environmental extracts are FDA-approved for allergen immunotherapy. (Immunotherapy for food allergies is still under investigation to determine the safest methods of treatment.) Only your allergy specialist can determine which type of treatment is the best fit for you or your child, so talk to your doctor. 

If you’re tired of taking medication every day for allergies or asthma, and want to treat the cause- allergen immunotherapy may be right for you. Find an allergist, and find relief!