DISCLAIMER: All blog entries are copyrighted. They are intended for information only. I have no financial conflict with any products mentioned. I want to share universal health care tips with you and your loved ones. I only share the information when I feel it will worth your time, attention, and not easily googleable. Therefore, the blog may not have new info frequently. The topic keywords are typed in bold, larger font, and arranged alphabetically except the last blog unnumbered, titled: How to maximize what your health insurance can do for you?c.
The most updated are: #11: How to Minimize Catching COLD/flu/bacteria, #16, MEDICAL Power of Attorney for physical health, mental health (separate form) and Living Will for anybody 18 years old and above, and the last blog, http://www.choosingwisely.org is added.
Be your own advocate!
Philosophy of SameDayFamilyMedicine.com by Li Schmidt, MD
How to make life simple? Only deal with what one must do or have to do in order to sleep well, pee well, poop well, and eat well. “Well” means healthy and balanced. Make the most direct/fewest steps and follow to live a simple and balanced life. Use one’s heart, brain, common logic, and be satisfied with what one has. If one is bugged enough by a concern, and is thinking about seeing a medical provider, one needs to jot down notes about the concern. If one wonders: should I write this down? The answer is: write this down. What is the concern? Has the concern interfered with sleep, pee, poop, and/or eating enough to disrupt one’s daily function? Has the concern happened before? If you do not write or prefer not to write, use a smart phone or a tape recorder.
How had the concern been helped before? When did the concern start? Where is the concern? What are the symptoms? What makes the concern better? What makes the concern worse? What is one’s own diagnosis? What are one’s worries? 90% of accurate diagnoses are based on adequate history records and physical exams. Bring the notes to the medical appointment(s). You are the best doctor to yourself! You are your best health insurance!
I promote the change of the traditional PCP acronym of “Primary Care Provider” to “Primary Care Professional”. Primary care provider is oneself. Primary Care Professional specializes in Family Medicine (who helps people from birth to earth, some provides OB care too), Pediatrics (who helps people from birth to 21 years old), and Internal Medicine (who helps people 18 years and above). Primary Care Professional works with a patient to improve self-primary-care-provide skills.
Nature (genetics), nurture (upbringing), and culture (the societies one lived and lives in) shape who we are!
Yesterday is a history, tomorrow is a mystery, and today is a present – adapted from a video called: Joy of Stress, in 1995.
Thank you for visiting.
- Posted 8-4-12: How to break an ABDUCTION: Yell “Fire” instead of “help”, “rape” etc to catch other people’s attention. When one hears “Fire”, that person wants to look and make sure him or herelf will not be in danger. Google “Just Yell Fire” to watch the free movie (about 47 minutes long) for girls 11-19 years old, though the website did require viewer to be 13 and above, and it asked for e-mail address before able to watch the movie. I think the website indirectly recommends 11-12 years old to watch the movie with an adult. The movie summarized if one feels the danger of being abducted: yell fire, straight arms up and face the abductor, slap ear, jab eyes, hit groin, and run.
- Posted 4-18-12: Free patient ADVOCATE service by a good organization for chronic diseases and financial difficulty even with medical insurance. Please call 1-800-532-5274 and/or check it out at www.patientadvocate.org.
- Posted 7-17-12: How and why to buy meats with no ANTIBIOTICS used to increase human survival when they are sick. Half way of http://www.consumerreports.org/cro/2012/06/antibiotics-are-widely-used-by-u-s-meat-industry/index.htm “labeling to look for” helps us how to tell.
- Posted on 3-26-12: ANTIBIOTICS DECREASE Birth Control Pills Efficacy, may decrease other chemical birth control methods, such as NuraRing, Norplant. At this point, Depo Provera injection is considered the only one does not interact with antibiotics as much. However, it is recommended to use non expired condoms as back up method while on antibiotics and 7 days after.
- Reposted on 09-27-13: ARSENIC, can cause cancer, especially bladder, skin cancer. I read an article of “arsenic in your food” from Consumer Report of Nov. 2012 page 22-27. It says Brown Rice has more arsenic than white rice. One need to wash brown rice before cooking, use 6:1 water:brown rice ratio instead of 2:1, and remove the water after the brown rice is cooked to minimize arsenic amount. I recommend oats, corns, sweet potato for carbohydrate source. Costco Oatmeal is soft and tastier than the usual tough oat. Anything contains brown rice syrup contains arsenic too. Avoid rice milk for now. Nature Valley announced that future products will not contain brown rice syrup. The article also mentioned that children under 5 years old, shall not drink rice drink or juice of apple and grape due to relatively high inorganic arsenic level. After 5 years old, if one loves that kind of drinks, please limit to no more than 1 cup (8 oz) a day.
- Posted 5-5-12: Little use of medications for Overactive or incontinence BLADDER : http://news.consumerreports.org/health/2012/04/overactive-bladder-drugs-do-little-to-ease-incontinence.html.
- Posted 4-12-12: BIRTH control pills containing “drospirenone” may increase blood clot risk more than other kinds of birth control pills. This is from the FDA (Food & Drug Administration) medical alert available on 4-10-12. Please read the ingredients of your medication package. So far, I know that Yaz, Yazmin, Ocella, and Angeliq contain “drospirenone”. All estrogen based birth control pills are contraindicated in people who smoke, family history, or personal history of blood clots. Birth control methods are mutual decisions between the sexual partners. The best method to avoid sexually transmitted diseases (STDs, same as sexually transmitted infections STIs) is: 1) No sex if yourself or partner has undiagnosed skin lesions, especially on private areas and/or the back of the throat. 2) If no undiagnosed skin lesions, use non-expired condoms appropriately. There are instructions with condom packages. The best birth control, with no worry of catching or transmitting STDs, is without hormone(s), such as male vasectomy (if no more children are desired for the rest of that person’s life time), female tubal ligation (if no more children are desired for the rest of that person’s life time), or condoms. However, condoms can cause irritations due to various spermicides and/or lubricants. The majority of condoms are made of latex. There are non-latex condoms. Trials will help one find a good match. Keeping a non-expired condom is wallet for people who do not have monogamous relationship helps to prevent unwanted consequences.
- Posted on Feb. 27, 2014:BOOKS recommended: I only read the books life changing and friendly.
“When Doctors Don’t Listen” how to avoid misdiagnoses and unnecessary tests by Leana Wen M.D. and Joshua Kosowsky, M.D. 2012. ISBN 978-0-312-59491-6.
- Posted on Feb. 22, 2012. BPA & Receipts: see http://www.post-gazette.com/pg/11353/1197566-114.stm if you do not know the subject. I tend not to accept receipts to save paper too. If I have to for possible return goods, I try not to use fingertips and pick up with minimum force.
- Posted on Oct. 9, 2012. Bad news about COFFEE. There has been news about how wonderful coffee is to our health. Recently, there was a research showed that coffee intake increased the probability of glaucoma due to the effect of caffeine. Glaucoma is the #1 cause for blindness. The caffeine in the coffee can also increase blood pressure and heart rate.
- Updated on 09-12-18. How to Minimize Catching COLD/flu/bacteria: As a family physician with American health care industry of profit mode where Urgent care facilities or hospitals are advertised by bulletin boards, patients are encouraged to see health professionals with a cold or flu, however, I do not get every cold/bacteria my patient brings in besides wearing gloves when touching open skin or private areas. Here is how I practice myself and what I recommend to the others.
Get adequate sleep. Sleep deprivation likely is a common cause of decreased immune system. This set up a stage for a cold/flu virus flourish in one’s body. Being stressed, worrisome, or pessimistic further weakens one’s immune system and may elongate the recovery time. If one has to be with an infected person, try to be about at least one arm length away from the infected person if able to. If any person, infected or not, does not hug their own cough/sneeze with both arms or at least with one inner elbow, please coach, help, and demand them to do so to decrease the spread the viruses via airborne. People can be contagious before they have symptoms or after feel/look fine.
Everyone needs to wash their fingertips thoroughly via singing/humming “happy birthday to me” twice in a row, frequently, before meals, after bathroom (soap if after bowel movement), and after blowing nose, touched nostrils, or any surface unclean to you. Do not use fingertips to touch nose tip or rub eyes. Alleviate any facial itchiness by reversing puckering lips, so the area between one’s nose tip and upper lip is stretched, or pulling down lower eyelid(s). If one has to touch nose tip/rub eyes, please use a clean tissue paper between their fingertips and nose tip/eyes. Use elbow, palm, knuckle(s), hip, or foot to touch objects, push buttons, or open doors. If not able to, please use a clean paper between your fingertips and the objects you have to touch. Keep your skin moist with non-fragrant cream/lotion etc to decrease itchiness.
- Posted 4-23-12: COMMON Sense Care– Link between fast food and depression per the reputable source: world-science.net/othernews/120402_fastfood
- Posted on 3-26-12: Check DRUG-drug, drug/supplement interactions with internet, and/or with your local pharmacist.
- Posted on 3-9-12: How to minimize or detect skin or body infections from CACTUS SPINES: If one got spine(s) into his/her skin, be sure to have all the spines removed as soon as possible and watch out for skin infection (red, pain, swollen, even pussy). If you feel sick, back pain, or not yourself even without fever in few days, make sure to check for blood or meningeal infections from spines in your skin. Be vigilant!
- Updated 5-2-16: How to FIND your dream health care provider for the first visit: If one is looking for preventative care recommendations like cholesterol screening, weight control, quit smoking, pap smear etc. ; check http://www.usPreventiveServicesTaskForce.org/Page/Name/tools-and-resources-for-better-preventive-care right lower corner with an apple motif “my healthfinder” for more detail. When one does not yet know the diagnosis, or has a concern, a Primary Care Provider (PCP), who specializes in Family Medicine (who help people from birth to earth, some provide OB care too), Pediatrics (who help people from birth to 21 years old), and Internal Medicine (who help people 18 years and above) is the best choice. Nurse practitioners are often good at listening to patients and thorough because they were nurses first. Seeing a gynecologist (Gyn) for routine well women exam is considered an overuse of Gyn talent. Gyn should be reserved for dealing with abnormal gyn issues that PCP cannot help, mainly surgical management. However, one may love to continue her well woman care with her Ob/Gyn because of positive experience during pregnancy and delivery. If one does not have medical insurance, the charges from Gyn may be higher. Local community health centers, like El Rio, is the best place for anyone who lives within Pima county, without medical insurance, and desires discount price. Ultimately, it is one’s personal choice. Besides word of mouth, one can also check reputable www.azmd.gov (for Arizona only, other states please click: http://www.fsmb.org/state-medical-boards/contacts). It is for M.D.s & Physician Assistants. Go to the links on the left column of the website homepage for other professionals, including D.O. (Doctor of Oestopathics). Nurse Practitioners are regulated by the nursing board. The website lists when the provider graduated from residency, which indirectly tells the experience level and if there is any disciplinary action. I found the following useful websites recently from Consumer Report to check on provider’s background including if receiving any money from pharmaceuticals. Small $ likely means free lunch provided by pharmaceutical companies, which is common. Here are the three websites: https://www.consumerreports.org/health/hospitals/ratings, http://docinfo.org/#!/search/query. Sorry that this website: https://projects.propublica.org/docdollars has to be copied and pasted in order to work. Be aware of other internet information. Much of them is not up to date. www.RateMDs.com (lower case is fine) is free and seems not limited to M.D.s, but it posts comments while checking the validity. Negative comments are not as useful as the positives. Check the provider out in person oneself. One has the absolute right to find another provider for whatever reason it may be. “The Customer is always right” is true in medical care provider selection.
- Updated on 09-12-18: Durable (means the validity of the forms end when the signed person deceases or revokes the power of attorneys. Here “attorney” does not mean a lawyer, it just means a designated person by the person who signed the forms as the “principal”. It is better understood as “representative”, “agent”, I like to say as “the spoke person”) MEDICAL Power of Attorney for physical health, mental health (separate form) and Living Will for anybody 18 years old and above: This website https://www.azag.gov/seniors/life-care-planning is for Arizona resident only. https://superiorcourt.maricopa.gov is a general good website with a “search” function, which includes financial power of attorney. Please check with your state official website of attorney general and superior court if you are not an Arizona resident.
- Posted on Feb. 22, 2012: Can one get few more days of daily prescription MEDICATIONS while waiting for renewal of a prescription? Yes, usually if one has been getting the medication from the same pharmacy. Besides following up with his/her doctor (or NP nurse practitioner or PA physician assistant) as planned, it is a good idea to check with his/her routine pharmacy about medication refill. Many times, the refill is done automatically. Even if it is not done yet and one runs out the daily medication, pharmacist will likely give couple days of emergency supply.
- Posted on March 5, 2013: Being outdoors also decreases NEAR sightness (myopia) according to Science News Feb. 9, 2013 issue page 22-25. I also heard in 2000 that no night light in baby’s bedroom before baby turns 18 month old helps to decrease near sight. Adults use red light flashlight to check on their babies when need.
- Posted 7-3-12: PAP related issues: First, check http://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care, right lower corner with apple motif “my healthfinder” for preventive care services recommended. If one wants to know more in depth, one may check the further right lower corner without apple motif for more detailed information which is written to guide health care providers. Check out http://womenshealth.gov/publications I also recommend to do Pap with office offers liquid base because per http://www.cancer.gov/cancertopics/factsheet/detection/Pap-HPV-testing: “In the United States, automated liquid-based Pap cytology testing has largely replaced conventional Pap tests. One advantage of liquid-based testing is that the same cell sample can also be tested for the presence of high-risk types of HPV, a process known as “Pap and HPV cotesting.” In addition, liquid-based cytology appears to reduce the likelihood of an unsatisfactory specimen. However, conventional and liquid-based Pap tests appear to have a similar ability to detect cellular abnormalities.”
- Posted on 3-26-12: Higher Risk of STDs (Sexual Transmitted Diseases) in Postmenopausal women: likely due to no worry of getting pregnant, more vaginal dryness, and lack of use condoms. I hope people do check partner’s private area skins and throats for rash and/or blisters. If they are present, non expired condoms will not prevent STDs either.
- Posted on Feb. 22, 2012: Under what situation, can one keep the same SPECIALIST for a while after loses the access? If one has chronic, or disabling, or is 2nd/3rd trimester pregnant and wants to continue with the same specialist, contact his/her insurance to see if one can continue the service for 90 days or until delivery.
- Posted 6-5-12: Regarding SPRAY Products, it is nice to know that it is a good idea to hold breath briefly so the particles will less likely go to lungs when using spraying sunscreen or any other spraying products.
- Posted 11-14-16: How to decrease STRESS:
Decrease internet tracking: duckduckgo.com does not track your search, sometimes, if youtube, may not play unless exposed, but helps.
10minutesemail.com will give you email address only functional for 10 to 20 minutes. It does not retain any personal data.
24. Posted 6-4-12: Common Sense: not all SUPPLEMENTS are good or safe. FDA alerted Rumofan Plus marketed as pain pill and made in Mexico is dangerous. See http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm306360.htm for detail.
25. Updated 5-2-16: Excellent information source about VITAMINS & Supplements was from Consumer Reports. I generally do not support any supplements without checking blood test, without work up why deficient. I support true natural remedies: clean air, clean water (faucet is fine if agrees with your taste buds), get some sunshine, get Mg, Calcium, etc., from green leafy vegetables which have better absorption too. Best supplements are directly from whole grain food, fresh green vegetables (broccoli,kale), fruits, fish, poultry, and appropriate sunshine. Again, common logic is the key. If the claims are sounded too good to be true, then they are likely not true. It is important to pay attention to our own body by connecting with what we have been eating or not eating to self-adjust before popping a vitamin pill. It is also good to eat different kinds of vegetables and fruits to get more complete vitamins and minerals supply, especially raw ones, except carrots/peppers. They are better absorbed once cooked. Vitamins & Supplements are also a profit driven business. With more and more things not made in the USA, the danger of no active ingredients and/or presence of toxic chemicals has increased. Many have wasted lots of money in buying Vitamins & Supplements. It is prudent for patients to check with their doctors, and/or pharmacists before starting supplements to see if the supplements are beneficial in their specific cases. My clinical experience has shown cranberry capsules help to prevent recurrent urinary tract infections. However, cranberry capsules have strong interaction with Coumadin. So, it is important to let your doctor know your desire for taking or not taking supplements, changing diet, adding or removing medications. This will help doctors decide if more medical monitoring for Coumadin or other issues is required. Lactobacillus Acidophilus helps to prevent yeast infections and/or antibiotic related diarrhea. Glucosamine and Chondroitin combined tablets helps to decrease pain from mild osteoarthritis (wear and tear arthritis). Try to buy from valid sources, such as USP (United States Pharmacopeia) verified , http://www.quality-supplements.org/verified-products/verified-products-listings. So far, to me, Kirkland (Costco products) and Puritan’s Pride seem to provide good quality.
26. Updated 07-29-17: WEBSITES recommended (listed alphabetically after www or http): Besides the websites cited in each blog post, here is the list of worth your time websites, usually no need to capitalize unless specifically noted:
https://www.commonsensemedia.org how to help navigate media/screen time.
http://www.consumerreports.org/doctors-hospitals/consumer-reports-names-hospitals-with-high-c-diff-infection-rates/?video_id=4381543898001, how to decrease infection rate if you are in a hospital. The video did not mention how often providers clean their stethoscope and place a glove over the stethoscope also if patient are in isolation rooms.
Dr. Schmidt discovered a remarkable Alexander Technique instructor in Tucson, AZ, Ellen Melamed (917-319-6311, http://ellensalexandertec.wix.com/tucson-az). Alexander Technique is not only good for musicians, but also for regular body poise and pain prevention and management.
www.familyDoctor.org (has Spanish too)
http://www.fda.gov/Safety/MedWatch/default.htm (There are other safety issues too, informative. So, the decision of taking medications is not a light one.)
www.kidsHealth.org (has Spanish and Audio features too)
http://strongfamiliesaz.com/, a network of free home visiting programs that helps families raise healthy children ready to succeed in school and in life. Our programs focus on pregnant women and families with children birth to age 5. Likely, similar program exists in other areas, seemed not affiliated with anything but a kind heart. I do not have personal or have heard any experience of this. I would love to hear feedbacks. Thanks.
27. Posted 5-8-12: New Side Effects & Contraindication of WEIGHT Loss Medication per PDR (Physician Desk Reference) 5-7-2012: XENICAL (orlistat) “is now contraindicated for use during pregnancy. There is also new safety information regarding lower gastrointestinal bleeding, and clarifying information regarding renal function and interactions with cyclosporine.” Eat less, move more is still the fundamental principle of weight loss. I heard from another physician website about 1 cookie=45 minutes of exercise. Exercise makes us feel good. Eat less is a far more effective and efficient way to lose weight. My service helps people develop how to eat less without medication(s)
28. Posted 4-23-12: Common logic Again, more X-RAYS can cause certain things you do not want. Even, dental x-rays. Here is the link from reputable source: world-science.net/othernews/120410_meningioma
29. Posted on Feb. 17, 2012. I am not able to take health insurance when my clinic opens because I want to use my heart, brain, and time to help patients, rather than dealing with the bureaucratic mess of insurance. I work for my patients, not insurances, drug companies, hospitals, pharmacies etc. However, it is important to help people who have insurance to know:
How to maximize what your health insurance can do for you?c
Updated 1-5-16: The best of the medical world is not to use insurance at all. The best health insurance is to take care of yourself so you don’t need to use insurance. Health insurance is a misnomer. It is a health care payment system. It is not like other types of insurance plans where a specific premium warrants a known and predicted out of pocket expense. It also does not encourage real free competition to provide high quality care. It forces providers and patients to go through all kinds of hoops and loops which are designed to help increase the bottom line for the health insurance companies: profit. Network providers have to see more patients than they should at discounted payment rates to keep their offices open. Patients are forced to want to see network providers to save their out of pocket cost. The vicious cycle perpetuates.
If you bought health insurance, it is important to know how to maximize what it can do for you.
Read your insurance brochure as soon as you receive it to familiarize yourself before a need arises. Pay attention to deductibles and copays. Yes it can be dreadful reading, but read it cover to cover. Read about the relationship between your insurance and Medicare (if you are on Medicare). Some insurance does not require you to buy Part D of Medicare. Use “Table of Contents” and “Index” to navigate. “Preventing Medical Mistakes” is an important section to read and practice.
Certain prevention/screening services are are investments for future good health. Some insurance offers prevention services without additional charges. Time is money. You want to be in control of all aspects of your health care, including spending. Unnecessary screenings cost more time and can cause unnecessary anxiety due to false positive results. Please check http://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care, click topic A-Z to find the details, for example, when to stop screening. Also may check http://www.choosingwisely.org. For children, well child visits and vaccines are covered up to 22 years old.
Have an advanced directive (living will & Medical power of attorney, if you want to prevent wasting unnecessary care, cost, and agony in prolonging poor quality.
Buy medications at Fry’s, or Costco if you have high deductible or your copay is a % instead of a fixed number of dollars. Mail order through your insurance for long term medications (90 days or more).
Be aware of special services your insurance offers: such as, if a nurse information line included. Some plans even include a “call a doc line”, tobacco cessation products coverage, discount gym costs, educational classes/programs for nutrition.
Some medical insurance, especially if it is high deductible, automatically includes dental and vision plans.
Many insurance companies allow network pharmacies give vaccines for no additional charge.
Always carry your insurance card(s) and related cards with you, (for example, Lab Card), especially when traveling. Some insurances plans cover out of country medical charges.
Try to use services of providers participating insurance network to save out of pocket cost. That includes lab and radiology facilities, anesthesiology and referred specialists. Ask your provider lab if there is an additional charge for a blood draw in the office. Double check to see if the provider still takes your insurance at the time of making and having an appointment, as they may change but not reflected on websites of insurance’s or even the provider’s.
When one is in a network hospital, unless the providers are hospital staff radiologists, anesthesiologists, emergency room, or pathologists, one still shall try to get other providers in network, such as the admitting doctor and, specialists for infectious disease, heart, lung, kidneys, surgery, gastroenterology (for tummy & liver), endocrine etc.
Be aware of your maximum benefit for the year for various services such as allergy testing or physical therapy. It is always good to ask the provider about medications and tests: What is this for? What happens if I do not do it? How will knowing the answer help me and my care? These questions force providers to think carefully in your situation instead of acting reflexively. It is absolutely OK to say No to a doctor. It is absolutely OK to change a doctor if you do not have a good gut feeling. You have the freedom in choosing what the best care is for you.
When you get a bill from your service provider, first thing to do is to make sure the service was given. If you feel the price is too high, check www.healthcarebluebook.org with your zip code to see the known price tag. Then, negotiate with the service provider if yours is higher.
Visits to a primary care doctor (primary care consult per Dr. Schmidt’s terminology) are a small portion of overall medical expenses. Having a trusted and high quality primary care consultant will save you in a long run. There are many primary care consultants who want to be free from insurance restraints and silly rules and, therefore, do not accept any health insurance. This allows the doctors to concentrate their time and expertise to help patients improve their health. Generally use network covered services for everything else, such as labs, image studies, hospitals etc.
Thank you for visiting the blog. Take care, Dr. Schmidt copyrighted