Physician Burnout

Physician Burnout

Physician Burnout

The prevalence of physician burnout starting from medical school training will shock you. Get the specifics and how to recognize this in your medical care setting. Doc Handal Speaks Up!

Pelvic Ultrasound

preg4Many of my female followers have probably already had a pelvic ultrasound (US), this week I had another one. I thought it would be a good idea to introduce/refresh about this test. It had been years since my last, in my case this was done to follow a medical condition. If you have ever had a pregnancy, you are familiar with this safe (no radiation exposure) and painless procedure. This simple investigative tool is used to exam other parts of the body, including the heart, blood vessels, liver to name a few

How It works: sound waves are bounced off our internal organs – ‘pelvic US’ – ovaries, uterus and bladder – showing not only shape, size but how blood flows to the organs. No menstrual flow can be occurring for this test.

Actual Test: There is no restriction to eating or drinking but you are told to drink at least two 8 oz glasses of water one hour before test. You must hold your urine, no bathroom stop on way into the sonographer’s room. The full bladder moves female organs into view and provides a solid contrast image.

A clear warm gel will be applied to your abdomen, then a slight pressure as the ‘transducer’ (a microphone like small long device) as is applied to your abdomen especially the lower.

Dependent on why the test was ordered the transducer may be covered with a plastic sleeve and placed 2″ – 3″ into your vagina during the exam. As you can reason this offers a view, a different angle that can assist in making or identifying a problem.

Typical time for this study is about 30 minutes, mine took 22 minutes and included the vaginal viewing.

FYI: Sonography technicians train for 16 – 20 months and are supervised by the radiologists (medical imaging physician). There are many training programs but not all however accredited by the Commission on Accreditation for Allied Health Education Programs. There are many certifying organizations; those that pass the American Registry for Diagnostic Medical Sonography can use RDMS after their name. Several states require licensure after completion of an examination. There are over 50,000 in the US (Bureau of Labor Statistics). As always whenever someone is involved with your well-being speak up if you feel any aspect of your exam is not ‘right’!

Cervical Cancer Screening – Simple Facts

A painless quick PAP test (named after the human papillomavirus-HPV) can detect abnormal tissue, HPV infection that can pelvic examlead to cervical cancer. High risks for developing abnormal cervical tissue or cervical cancer include: intercourse at an early age, multiple partners, history of the sexually transmitted diseases (STD)- genital warts (caused by HPV virus) or herpes, HIV injection or immune deficiency (ex. transplant recipient). Also smoking has been associated wither casual or directly with abnormal cervical tissue. As always you need to be totally honest with your health care provider most especially as regards your sexual history.

Generally speaking women age 21 – 29 should have a Pap test every 3 years, thereafter till age 65 every 5 years. After age 65 you can stop having a Pap test!

As in too many medical procedural tests a false positive or false-negative are possible. To decrease odds follow these simple steps: no douching, use vaginal medication, spermicide or lubrication for 3 days before the test.

If your report reveals abnormalities ask for details the specifics and the significance. Cell abnormalities can be from the outer or the inner cervix or they can contain changes of ‘low or ‘high’ grade signifying “precancer” or the test result might show cancer cells. It might not be a simple positive or negative.


Medical Radiation Exposure

It is well-known many cancers are caused by radiation exposure, even the sun radiation cause skin cancer the #1 cancer in MH900360996the US. Medical radiation exposure is your responsibility! Every wonder what happens to all the radiation you receive when you have ‘medical imaging’ tests for such things as broken bones, stomach pains, headache, heart disease? Sadly it accumulates in your body! If you want to calculate how much you have in your body, check out the website calculator by The American Society of Radiologic Technologists –  it is user-friendly.

Some tests expose you to small amounts others too much more. Radiation, harmful rays of ionizing energy, cause not just skin cancer but blood and other cancers result from our bodies being dosed. Before you have another test read this useful patient info.

Before you agree to exposure to these harmful rays ask “what difference the results would make in your care’.

Online Pharmacy Dangers

MH900390552A recent FDA study -1 in 4 Americans have purchased prescription medicines online. At this writing there are approximately 35,000 – 50,000 online drug-seller websites.

Recently, the Government Accountability Office (GAO) released a report, Internet Pharmacies: Federal Agencies and States Face Challenges Combating Rogue Sites, Particularly Those Abroad detailing the large and grave problem of illegal, online pharmacies. You need to know it concluded that 97% of all online drug sellers operate illegally.  In 2012 FDA sent warning letters to one internet company ‘’.

FYI: It is illegal to in the US to get prescription meds without having had a recent medical evaluation – that is one needs a valid prescription. There are many good health reasons this is so:

– you may have been taking medication in the past but your body and it reaction to the medication can change with time,

– do you need a stronger dosage,

– are you having complications

– no or not sufficient improvement with the medication

All too common many of the medications purchased online are counterfeits or misbranded drugs.

HONESTLY – Do you want to put a chemical that you purchased from an illegitimate sources into your body?

Men: When You Eat Matters to Your Heart!

DocHandal tries to bring you the latest research findings that docs like herself read and use. This blog hopes to share some and guide you to reading more, after all it is your body guys!MH900188491

American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 Update*  This study looked at 26,902 men, ages 45 to 82, free from cardiovascular disease and cancer at the start of a 16-year study. Researchers found those who skip breakfast or eat late at night could be at increased risk of developing coronary heart disease. Specifically for this study male health professionals were used. They freely admitted they regularly skipped breakfast, and were found 27% more likely to die while those who ate late at night had a 55% increase in cardiac death.

Important to note it did not appear to matter how frequently they ate a day.

REsearchers caution that, these associations appeared to be mediated by BMI (body mass index), development of hypertension, hypercholesterolemia, and diabetes over the years of the study.

A must read (quick) is the current guidelines by USDA and DHHS for diet.


HIV Test – New & Better

t cellFDA just (August 9th) approved the first rapid finger stick Human Immunodeficiency Virus (HIV) test that not only reveals if you have antibodies to HIV -1 or 2 but if you only have the virus (i.e. you have the antigen p-24)!  In this 20 minute test the presence of  the virus can be found  12-26 days after exposure. Prior to this 4th generation test one would have to wait till your body made antibodies – anywhere from 20-45 days after exposure. Note: this test however does not distinguish between antibodies to HIV-1 vs. HIV-2.

Now health care professionals have a quick tool that can independently distinguishes in a single test HIV antigen from HIV antibodies. Early infections yield antigen positive while only when the body starts fighting do HIV antibody develop.

Why this is a ‘big deal’ is  you could be walking around undiagnosed spreading HIV infection because your body has not made antibodies.  NOW infection can be recognized,  treatment, and prevent spreading HIV infeon. At this writing the Centers for Disease Control and Prevention (CDC) estimates that in US each year approximately 50,000 people are infected with HIV. Of the more than 1 million people living with HIV, approximately 20%  have not been diagnosed.

 BACKGROUND: Being injected with the HIV virus can lead to Acquired Immune Deficiency Syndrome, or AIDS. This virus damages your body’s immune (defense) system – by destroying CD4+ T blood cells which are key to fighting diseases. At present there are two types of the virus- HIV-1 and HIV-2. HIV-1 is worldwide while to date HIV-2 is mostly in West Africa, although increasingly HIV-2 is being reported cases in Europe and North America.

Medical Tests – Ask Why & Get Results

Seems nowadays you can’t get out of office visit, ER or hospital without one or many tests. Seems many of my colleagues never touch the patient but order tests including cardiac catheterization to biopsy.

Anytime you are subjected to a medical test presume there is a reason and those results are important. Yes often they are ordered in the name of prevented care adlib mammogram, colonoscopy, ECG and the like.ecg

You should know why any test is ordered, exactly how will a result mean to how you are cared for. There are tests that are ‘nice to know’ but not necessary for good medical care.  So since you are the one being exposed to radiation, needles and tubes – speak up – ask till you understand. Don’t be shocked if then the test is not ordered!

I have long said never get an ECG (EKG) without asking for a copy to keep in your wallet or take a photo of to have in your smartphone. Please take a few minutes to go to DocHandal’s (iTunes)  podcast channel “Listen Up” and listen to the podcast titled ‘Healthy Wallet”.  You may have to pay for personal copies however if your medical records are being sent to another medical care provider there is no charge. Transfer of medical information between caregivers is part of ‘continuity of care’, something that is required by law.

Finally patients are freely given a DVD/CD of their imaging study -for example an Ultrasound or CT scan. So why get a copy of medical tests? Take it to appointments often you need to take this to the ordering medical provider who may get the written reports later than your copy of the test/study. Many capable physicians are able to interpret and actually prefer to interpret the imaging study rather than just rely on the report.

It is your health, body and you are responsible for it!

Drug Reactions & Side Effects – You Can Act

MH900104752When a negative ‘surprise’ (or abnormal experience) occurs after taking medications or using a medical device – you can easily take action.  Means are available and include bedsides the obvious of calling the pharmacy or medical subscriber – you can ‘go to’ the FDA! The FDA website (medwatch) is a plethora of information with plenty of research  and you can also report your concern.

Examples of concern include:

  •  it occurs to you that there might be a problem with the quality of the drug, product or medical device
  • often you were taking a drug that worked then you were switched to a different manufacturer (usually a generic company) by the pharmacy or your insurance plan only to have it not ‘work’
  • experience a reaction you believe to be a side effect – new symptoms or worsening symptoms after taking  a drug or using a medical product/device
  • took a drug, or used a medical device incorrectly and it may have had a negative/unsafe effect for you.

Know there are many ways for YOU to address any of the above possible concerns:

-anyone can call the FDA at 1-800-332-1080 or go to their help website.

– a specific form (MEDWATCH Consumer Voluntary Reporting)  can be filled in online or printed and mailed in. Please consider using this reporting mechanism.

If you are researching or want to know about a specific drug or device – your source should be  ‘medwatch’ – a free ‘.gov’ site of the FDA. Here anyone can have access to info about such things as tobacco products, cosmetics, including veterinary products it is a great ‘go to’ site. Want to know about foods and especially current recalls and outbreaks this site is the way to find out.  I was glad to see also covered was ‘dietary supplements’ – we all take so many of them.

This is a superb all-inclusive FREE info site!