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Who is the best doctor?

I recently spoke to Dr. Jorge Mestman about the issue of finding a good doctor. I asked him if consumer ratings of physicians would help patients find their way to better care and he responded with a resounding “no.” I was somewhat taken aback and asked why he felt that way. What he said was surprising (this is not actually a direct quote, I’m summarizing):

“The best doctor is YOUR doctor. Over time a physician develops a relationship with a patient and an understanding of their issues that is very valuable. The problem with seeing a specialist is that they have no baseline to compare you to – they may make recommendations based on their best analysis of the situation at that point in time. But they can be wrong.

Also, physicians – like any human being – have different skills and styles. Some are great listeners and excel in empathy, others have a ‘tough love’ approach, still others are research oriented and like to delve into the ‘nitty gritty.’ How can one person’s rating capture all of that? Most physicians are good people with good clinical skills. The right one is the one that you like. Also, it’s simply not possible for a few highly rated physicians to care for vast numbers of patients. If people limited themselves to only seeing certain physicians (who got high ratings), they’d be turned away due to the over-demand.”

What do you think of Dr. Mestman’s analysis?

Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Staying alive linked to staying in school?

So it seems that people who stay in school longer, live longer.  But not for the reasons you might expect – it’s not because privileged kids are more likely to stay in school and also happen to get better healthcare.  It seems that school teaches kids two things beyond the books: 1) discipline – the ability to delay gratification and 2) social networking skills.  These two lessons go a long way to keeping people healthier long term.

Come to think of it, this makes a lot of sense – if a person can learn to avoid fast food for the “higher call” of health, they may live longer.  If a person is well integrated in a social network, they’re more likely to seek out medical assistance earlier on – and have caring friends and family spur them on towards regular check ups, taking their meds, etc.

Now, I don’t know what YOU were doing in junior high and high school – but apparently the first hints of your discipline and networking skills were learned there.   Although the research described in the NY Times article only made a link between total years in school, and total years of life – I wonder if your high school’s  “expert networkers” – you know them, the ever-annoying popular kids – will fare best of all in the health arena?

Better go to your high school reunion to find out!


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Do glucosamine and chondroitin sulfate reduce arthritis pain?

Many people use glucosamine and chondroitin sulfate as a natural therapy to treat their arthritis pain.  This seems like a reasonable thing to do since glucosamine is a critical building block for cartilage, and chondroitin can help keep joints properly hydrated.  And as we know, osteoarthritis is caused by joint wear and tear and decreased cartilage health.

Unfortunately, the research results have been fairly underwhelming.

Here is how one author* summarized the latest research:

“It seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone has been shown to be more efficacious than placebo for the treatment of knee pain. If patients choose to take dietary supplements to control their symptoms, they should be advised to take glucosamine sulfate rather than glucosamine hydrochloride and, for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect. Three months of treatment is a sufficient period for the evaluation of efficacy; if there is no clinically significant decrease in symptoms by this time, the supplements should be discontinued. Furthermore, there is no evidence that these agents prevent osteoarthritis in healthy persons or in persons with knee pain but normal radiographs.”

So I guess the bottom line is that these supplements are no magic cure for knee pain – they aren’t known to be harmful (except to the wallet) but they aren’t sure to be helpful either.

*Hochberg, Marc C.
Nutritional Supplements for Knee Osteoarthritis — Still No Resolution
N Engl J Med 2006 354: 858-860

Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Are Pet Owners Really More Unhealthy?

As I was reviewing some research articles for a blog I was planning about the benefits of pet therapy in pain management, I came across a recent Finnish study suggesting that pet owners are more likely to be overweight and unhealthy than those who had no pets.  It just didn’t seem right to me – so I decided to go to the source and read the original article.

The researchers surveyed about 8 thousand people.  They found that a total of 80% of those with pets and 82% of those without pets reported good health.

They also said,

“In the multivariate ordinal logistic regression analysis, perceived health was no longer associated with pet ownership. When investigating which explanatory variables included in the model caused the disappearance of the statistical significance, basic education, form of housing, or BMI did so.”

Translation:  being at risk for poorer health is not really about your pet, it’s about your socio-economic status and the degree to which you are overweight.

But this still begs the question: why are Finnish people in poorer health more likely to have a pet?

The authors offer this explanation:

“Pets seem to be part of the lives of older people who have settled down and experience an increase in the number of illnesses, whereas young healthy single people have no time, need, or possibility for a pet.”

Hmmm.  Would an American survey find similar results I wonder?  Is there any cultural bias in these data?  What do you think?  Are American pet owners more likely to be overweight and socio-economically challenged than non-pet owners?

Source:  Koivusilta, L. and Ojanlatva, A. PloS ONE, December 2006; vol 1: pp e109. News release, Public Library of Science.


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

An unusual cause of plantar fasciitis

Good medical diagnosis and treatment often requires some detective work.  One of my patients came to see me for foot pain recently.  She described what sounded like a pretty typical case of plantar fasciitis – pain in the heel of her foot, worst with the first few steps in the morning, improving throughout the day.  I recommended stretches, physical therapy, night splints, ibuprofen… but to my surprise nothing was really helping.

One wintery day she came back on a return visit and I happened to notice her footwear – boots with a very thin, flexible sole.  Slowly I began to think of her tromping over ice, sand, gravel, and snow in these boots…  I asked her if she could feel the ground under her feet.

“Yes, I can feel everything – I don’t like to walk around in the snow and ice because it kind of hurts to step on all the lumps and bumps.  But I can’t just stay indoors all day, I have errands to run!”

I explained to my patient that I had a hunch that the rocks were bruising her plantar fascia, causing it to be inflamed and painful.  I asked her to buy herself some thick soled boots – the kind where she couldn’t feel the lumps and bumps under her feet.

About a week later my patient called to tell me that her foot pain was much better.  The new boots seemed to be doing the trick…  “I never knew why my plantar fasciitis got worse in the winter times, doc.  I thought it was the cold that made things worse.”

Well, I had learned a lot too… sometimes the best treatment option is not on the standard protocol list.  The power of observation is one of a physician’s most important weapons.


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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