My friend and fellow blogger Kerri Morrone Sparling has created a photo montage (one photo taken each day for 365 consecutive days) of her life with diabetes. It is a fascinating pictorial experience that somehow captures the reality of the disease – and living life to the fullest despite daily blood sugar monitoring.
Please take the time to experience it here.
Not only am I welcoming in a new year, but also a new opportunity. This is my first blog on getbetterhealth.com, and I am very excited. I previously worked with Dr. Val at Revolution Health, where I was a pediatric consultant and blogger, and I now have the good fortune of working with her on her new health website.
I plan on blogging regularly and look forward to getting to know you better – your interests, questions, and goals. Actually, I would love to learn what you want from me and how I can best serve you. It might help if I first tell you about myself and my own interests. I am a pediatrician in private practice in Maryland. I am also a blogger, speaker and writer. I just finished my first book, “Anorexia,” for ABC-CLIO and recently wrote a story which will appear in a book about pediatricians, which is being edited by Dr. Perri Klass and published by Kaplan Publishing.
I love to teach. One of my favorite aspects of pediatrics is educating parents and kids, whether it’s about breastfeeding, asthma, puberty, or the latest clinical research. I love to travel and learn about new cultures. My late-husband and I spent three years working at the Kayenta Health Center on the Navajo Reservation, where we were constantly learning about health-related customs and decisions which were so different from our own.
And I love my children. I have two wonderful daughters (if I must say so myself), ages 13 and 10 years. I enjoy writing about them in my blogs occasionally. It hasn’t bothered them yet, but I assume I will soon have to be careful about what I divulge with regards to my teenager.
A very sad part of my life was the death of my incredible husband almost four years ago. He was diagnosed with a glioblastoma, a type of brain tumor, on his 40th birthday, and died exactly one year later. His illness and death were not only difficult for obvious reasons, but also because the location of the tumor caused significant personality changes and the loss of his ability to do every day things which we take for granted, such as motivating himself to stand up from a sitting position. I learned more than I ever wanted to know about the pitfalls of the health care system and how to look for clinical research trials. Since my husband became ill, I have been working on a book for children whose parents have cancer. I am determined to finish it.
I think that’s enough about me. Now I’d like to know about you. I want to know what your issues and concerns are, and what you would like me to discuss and blog about. Let’s make this year our best and most productive yet!
Stacy Beller Stryer, M.D., FAAP
Can you think of a really good caption for this medical cartoon? The winner will receive a Better Health t-shirt, effusive praise, and bragging rights. The winning caption will be chosen on the basis of subjective criteria by a panel of 3 judges of variable wit. List your captions in the comments section. Enjoy!
By Steve Simmons, MD
In order to solve the increasing shortage of primary care doctors many experts have proposed a plan to fill the void with nurse practitioners (NPs). This acknowledges the necessary role primary care plays in our health care system while ignoring the actual qualifications for the job. Furthermore, by failing to address why doctors are leaving primary care these experts unwittingly will ensnare us further in the same trap we currently find ourselves in today. Independent of whether or not nurse practitioners are qualified to practice medicine without a supervising doctor is the following fact: they are avoiding primary care medicine for the same reasons as doctors.
As we determine who will take the lead on providing primary care, we should consider what is best for our patients. Nurse practitioners fill an invaluable role by taking on many of the day-to-day problems and there is little doubt that our patients benefit from their skill and experience. Anyone suggesting that nurse practitioners can replace physicians should understand that the nurse practitioners’ training program teaches them to provide care within the structure of a healthcare team led by a supervising doctor.
What can doctors provide their patients that nurse practitioners cannot? Depth of knowledge. Seven years of study in medical school and residency provide a doctor with the depth to understand complex medical conditions more difficult than the average day-to-day medical problem. With experience, many nurse practitioners can provide excellent care for patients suffering a difficult or unusual problem; yet without that experience this lack of depth can be the difference between a good and bad outcome.
A very good nurse practitioner I work with once said, “I am only as good as the doctor backing me up, when I am working with a good doctor, I’m great.” This helps exemplify how nurse practitioners can rely on physician supervision to help prevent unnecessary tests, procedures, and misdiagnoses.
When a patient needs the care of a specialist, a nurse practitioner might find it difficult to advocate for the patient without the necessary parity of experience with the specialist. In my training, it was unthinkable to give absolute control of a patient to a specialist. Specialists need to focus often leaves them unable to best serve the overall interests of the patient. While no primary care doctor can perform a highly technical procedure on their patient, they can advise as to whether the procedure is necessary or not. Every patient needs someone to coordinate their care plan while keeping in mind his overall best interests. An unsupervised nurse practitioner may find it intimidating to tell the enthusiastic specialist “no” while advocating for what is best overall for the patient.
The idea that you can replace a doctor with a nurse practitioner does not address the underlying problems that will continue to drive all healthcare providers away from primary care medicine. I hope that anyone suggesting a solution for the shortage of primary care doctors tries to understand why the shortage has occurred in the first place. Then and only then will there be enough primary care providers to care for us all.
Until next time, I remain yours in primary care,
Steve Simmons, MD
Dr. Richard Carmona
Intense debate has broken out across the blogosphere regarding the candidacy of CNN medical correspondent, Sanjay Gupta, for the Office of Surgeon General of the United States. Some argue that he is not qualified for the position, others say that his charisma would be a boon to public health communications. But before we draw conclusions about who’s right for the job, we need to understand what the job entails.
I asked Dr. Richard Carmona, 17th Surgeon General of the United States, to explain the roles and responsibilities of the office. You may listen to our conversation by clicking on the podcast below, or read the summary of our conversation that follows.
[Audio: http://blog.getbetterhealth.com/wp-content/uploads/2009/01/surgeongeneraljob.mp3]
Dr. Val: What is the primary role of the Surgeon General?
Dr. Carmona: It’s the Surgeon General’s responsibility to protect, promote, and advance the health safety and security of the United States. The office of the Surgeon General dates back to 1798, when President Adams passed a law to create the Marine Hospital Service. The lead physician of the service became known as the Surgeon General. The Marine Hospital Service eventually became the US Public Health Service, and the roles and responsibilities of the Surgeon General broadened to include immigration, disaster preparedness (in the case of nuclear and biological warfare), national safety, health prevention, and many complex public health issues that face our nation and the world.
Dr. Val: What sort of experience is appropriate for a candidate of the office of Surgeon General?
Dr. Carmona: A successful candidate for the office of Surgeon General should have deep and broad public health experience, especially as a public health or uniformed military officer. The Surgeon General is given the rank of Admiral, and as such he or she will interface with other Admirals and Generals, and Army and Navy Surgeon Generals, most of whom are career officers with decades of experience in military matters. The Surgeon General must have the wisdom and experience to take on the position of an Admiral and represent our country internationally.
Dr. Val: What does the Surgeon General do on a daily basis?
Dr. Carmona: The Surgeon General is the commander of the US Public Health Service Commissioned Corps, which consists of thousands of officers in hundreds of locations around the world working anonymously to keep our nation and our world safe. The Surgeon General interfaces on a daily basis with the NIH, CDC, SAMHSA, HRSA, and all of the federally related health agencies as well as global health organizations like the World Health Organization, Pan American Health Association, and the American Public Health Association. The Surgeon General provides in-depth analysis of health policy for every cabinet minister, including the Interior, Commerce, and Homeland Security. It’s a very visible, credible, and iconic position.
Dr. Val: What’s the selection process for the office of Surgeon General?
Dr. Carmona: The Surgeon General is nominated by the President of the United States after much due diligence, and under the recommendation of his staff. The candidate is then introduced to the United States Senate. Then the Senate, if they so choose, extends the candidate the privilege of appearing before them for a Senate confirmation hearing. During the hearing they review the candidate’s credentials and ask him or her questions about anything and everything related to the public health of this nation and the world. You’re essentially put in a hot seat, and rightfully so because the Surgeon General is America’s face of public health to the world.
Dr. Val: What should Americans expect of their Surgeon General?
Dr. Carmona: The Surgeon General of the United States needs to remain a non-partisan physician. He or she should always communicate the honest, scientific truth to the American public so that they can make informed decisions about improving their health. Often, that scientific information is not the same as the policy that the President or Congress come out with, because policy is a very complicated process.
The Surgeon General has the largest medical practice in the nation (300 million), and when he or she issues reports, they actually change behavior in our country and the world. The Surgeon General is the true, honest broker of the best science for the people, offered in an a-political fashion. He or she is a patient advocate at the very highest level of government, and is expected to address the most complex health problems that face our nation. There is no more important or influential office that an American physician can hold.
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