Look Your Best This Year & The Next

My Testosterone Is Low But My Doc Doesn’t Know

Thanks for the reader feedback from my previous article on low thyroid! Quite a few readers have commented on my unconventional approach to thyroid disease. I have used this approach quite successfully to help our weight loss patients get closer to achieving their goals.

Gals- Lest you think this article is targeted at the guys; read on. The sole female on the winning team of HEAL and The Nest’s Deacon Bob Racicot Open held August 10, 2013 had an advantage. Her testosterone level was NORMAL! Could she hit balls farther, walk faster, and tolerate men better than any other woman on the course? You bet! (She said it was okay to mention this anecdote in conjunction with a plug for two wonderful organizations.)

How do we diagnose low testosterone (low T)? I think an evaluation of symptoms is the best place to start. Signs and symptoms of low T in men and women include fatigue, anxiety, depression, weight gain, memory loss, muscle loss, bone loss- both kinds (think about it), hair loss, elevated cholesterol, insomnia/poor sleep, sleep apnea, and decreased libido to name a few.

What about lab tests? The American College of Obstetricians and Gynecologists doesn’t even recommend checking lab values in perimenopausal women (average ages 40-61 but can occur much earlier). This is where things get weird. They recommend treating perimenopausal women based on their SYMPTOMS! “Ughhh! You mean I have to listen to a patient tell me how they feel?” Yes! In my practice I start with a symptom questionnaire and ask the patients to elaborate when appropriate.

For guys? Men normally have higher testosterone levels than women and I will draw baseline labs before starting testosterone replacement. I frequently see patients who tell me “My primary care doc checked my testosterone and told me it was normal.” Total testosterone IS typically normal in the majority of patients. What does that mean? Testosterone is tightly bound by Sex Hormone Binding Globulin (SHBG). As near as I can figure out, SHBG prevents young men from exploding out of their pants as they enter puberty. After that, I’m not sure what role it plays other than making us miserable…

An analogy I like to use for testosterone is that of an 18-wheel fuel tanker. As you are driving along Sudderth you realize that not only has the NMDOT conspired to make traffic difficult, but there is a fuel tanker on the side of the road that is contributing to the “Texan Trickle” (I can say this because I am, in fact, a Texan). As you crawl to a stop beside the tanker you roll down your window for some trivia and ask the driver how much fuel he can carry. “I’m pulling a full load now with 11,000 gallons of diesel,” he says. You decide to ask why he’s impeding the flow of traffic, to which he replies curtly “I ran out of fuel in this *@!#! stop and go traffic!”

Hmm. A tanker full of diesel but the truck ran out of fuel? Why? There isn’t a connection between the trailer tank and the much smaller fuel tank on the truck. The fuel is tightly bound by the trailer tank. Total fuel looks great. Free fuel, or fuel available to the engine, is GONE.

Is there a test to measure testosterone that isn’t bound to SHBG? It’s called free testosterone! 100% of the patients I have seen that have symptoms of low T have either low or borderline low free T.

Got symptoms of low T? Come talk to me.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that testosterone allows his wife to put up with him (most of the time). Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Life After Sex

 

For those readers expecting a metaphysical article that delves into the true meaning of life- read no further.

Many of the patients I see are in their late 60’s, 70’s, and 80’s. I have all my patients complete a hormone self-assessment (rating symptoms between 0 for no symptoms and 10 for severe) and I will usually comment on the higher numbers. If someone in the mid 40’s and older answers 0 for libido/sex drive, painful intercourse, and inability to reach orgasm (indicating no problems) I know that they aren’t having sex. I’ll ask when was the last time they had sex (often greater than one year) and if they are happy with the transition from sex to no sex.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He has vowed to protect his wife from the attacks of other zombies as long as she doesn’t attack him. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

My Thyroid Is Low But My Doc Doesn’t Know

Based on reader feedback from my last article (Love and Marriage) I thought I needed to clarify an issue. My wife isn’t a zombie. She only occasionally acts like one and that behavior is usually provoked by a certain someone in her life. She is an excellent physician and her obstetric and gynecology patients need not fear any irrational behavior (unless I’m around).

My anti-aging and wellness practice includes medical weight loss. As such, I see quite a few patients that have experienced the “middle age spread”. Not familiar with the term? According to Dictionary.com, middle age spread is defined as “an increase in bulk, especially in the waist and buttocks, associated with the onset of middle age and the body’s decreasing ability to metabolize calories efficiently.”

Why does the body have a decreased ability to metabolize calories efficiently? One of the main reasons is a decrease in hormone levels. Most of my patients have a similar story. They were able to maintain a healthy weight when they were younger; but kids, work, and decreased time for exercise began to show on the scales and the clothing rack. Typically they have tried to lose weight through diet and exercise and come to see me when the avenues that worked previously are no longer effective.

Many have seen their primary care doc, their thyroid level has been checked and come back “normal”, and they have been told that they just needed to eat less and exercise more. How do we define a normal thyroid level? We compare the patient’s TSH (thyroid stimulating hormone) level, not against the patient’s baseline blood levels drawn when they were younger, but against other people in their age range who likely had their blood drawn because they were experiencing similar symptoms.

The TSH test is a screening test developed to detect very high and very low levels of thyroid production. Thyroid stimulating hormone is produced by the brain, not the thyroid, as part of the metabolic feedback mechanism. The TSH test’s broad range doesn’t do an adequate job in detecting early decreases in thyroid production. Free T4, free thyroid hormone released by the thyroid gland, is a much more accurate test that shows the level of thyroid hormone circulating in the bloodstream.

Typical Western medical education now centers more around looking at test results on paper than looking at the patient’s symptoms. It’s easier to treat the paper than the patient! After all, why should we trust that the patient knows their body better than we do?

What are the symptoms of low thyroid? Fatigue (Chronic Fatigue Syndrome), depression, weight gain, changes in hair, skin, and nails, increased cholesterol, cold intolerance, fibromyalgia, constipation, forgetfulness, and low sex drive to name a few. Don’t recognize any of your symptoms on this list? Visit www.StopTheThyroidMadness.com for a more complete list. Though not written by a doc, I haven’t seen anything yet with which I don’t agree.

My patients? I will typically start with a baseline TSH and free T4. If the patient has any of the above symptoms and the TSH is on the higher end of normal with a lower end of normal free T4 I’ll start them on natural thyroid supplementation (Armour/ Naturethroid/Westhroid). What about Synthroid/levothyroxine (synthetic T4)? I have quite a few patients that have had poor response to Synthroid that have great response to natural thyroid such as Armour. Do I follow TSH? Long enough to see that it comes down to the low normal or low range as long as the free T4 (and sometimes free T3) are in the normal range with good symptom control. TSH was never designed to track the effects of thyroid replacement. My job is to listen to my patients and work with them to reach their goals and help make their lives better.

 

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that thinking inside the box doesn’t work and that zombies aren’t really real (other than his wife). Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

 

Love and Marriage

Love and marriage, love and marriage,
Go together like a horse and carriage.
This I tell ya, brother, you can’t have one without the other.

Love and Marriage, written by Sammy Cahn and Jimmy Van Heusen and sung by Ol’ Blue Eyes himself. Frank Sinatra made the song so popular it was used as the theme song for the sitcom Married with Children. Quite a catchy tune, but it doesn’t quite ring true.

Last weekend I had the opportunity to accompany my wife and kids to a wedding in Santa Fe. A more relaxed wedding, it was held at Hyde Park Lodge. The drive itself was both provoking and exciting. The severe rains from the night before had washed some of the mountainside onto the winding mountain road, provoking my wife to suggest that we were obviously on the wrong road. I stopped the car twice to ask directions to ensure that we were, indeed, on the correct road and arrived in time to see the bride walk down the aisle. (Yes, guys CAN ask for directions). My comments to my lovely navigator of the past nine years were also apparently provoking, as it took some time for both of us to cool off after the ride. Santa Fe is a great place to cool off!

The wedding vows were a bit different from the classic vows, and included a bit about her duty to excuse him from household chores during football season and his duty to protect her during possible zombie attacks. I had to refrain from letting the audience know that I just narrowly escaped an attack from a crazed zombie on the way to the wedding. How did she get in the car? She looked like my wife when we started out, but her mindless lack of navigation skills (she was holding the iPad) and violent motions toward me and my comments convinced me of my narrow escape.

My kids both enjoyed the wedding (mainly due to it’s brevity) and we all enjoyed the dancing and family reunion atmosphere afterwards. I’ve had an opportunity to reflect on both my marriage as well as marriage in general since the wedding and have come to a few conclusions.

Love and marriage don’t necessarily go together like a horse and carriage (unless you factor in the horse pulling the carriage off the road into a bar ditch during a heavy rain). Marriage can exist long after the love is gone. Most people get married because they truly love each other; keeping the love healthy requires work. Failure to effectively communicate with your spouse is the number one reason for failed marriages (my own anecdotal observation, but think about it…).

There are many ways to communicate with your spouse. Men communicate better in the physical plane (sex), while women lean toward the emotional aspect (body language and words). Marriage is a compromise! We start out speaking two different languages and if we aren’t attentive to the message received it is easy to miscommunicate. Miscommunication has to be effectively addressed to move forward in the relationship. Guys- hold your wife’s hand and walk beside her when you are out on a date (make sure you take her out on dates). Gals- a massage unencumbered by clothing is almost impossible to resist (think happy ending).

Don’t think that my marriage is without pitfalls and compromises. (The horse and carriage in a flooded ditch comes to mind). We both make mistakes, but we are committed to staying in love with each other despite the amount of work required. This article is a love letter to my wife (I have to say that so she won’t try to eat my brain)- try writing one yourself! Love and marriage requires work to stay out of the ditch. I always encourage my readers to work on improving their personal health. Work on improving the health of your marriage this month!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He has vowed to protect his wife from the attacks of other zombies as long as she doesn’t attack him. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Pilots

To paraphrase a quote from Sir William Osler: “Listen to your patients long enough and they will tell you what’s wrong.” Great advice from one of the greatest diagnosticians in the medical world, and advice that I use on a regular basis in my wellness practice. That same advice can sometimes be dangerous from a time management point of view when dealing with certain populations.

I’m writing this article from Oklahoma City, Oklahoma. I’m in Oklahoma to receive the official FAA (Federal Aviation Administration) training required to complete flight physicals for the civilian population. Some might think that being an Air Force flight surgeon would allow me to do FAA flight physicals without any additional training. Our federal government doesn’t share the same opinion…

The FAA’s training mirrors much of what is taught in typical flight surgeon training. Flight surgeons and civilian AMEs (Aviation Medical Examiners) both are charged with ensuring that the pilots we take care of are fit to fly. Military docs have an easier job most of the time, as the military rigorously screens pilots prior to investing 1.5 million dollars in training funds. Civilian pilots are motivated to stay fit, but the majority won’t lose their day jobs if they don’t.

Pilots are special and they know it- just ask ‘em! Pilots would rather talk about flying than health issues. If you listen to a pilot long enough they are more likely to tell you flying stories than about potential illness, thus necessitating the training to get them back on track.

Pilots want to talk about flying. They come in for an annual physical for two primary reasons. 1) They are required to visit a flight doc to maintain certification. 2) They know their flight surgeon/AME is willing to listen to at least one of their stories. (Listening to stories isn’t currently required by FAA regulation but it is certainly taught during training).

What does this have to do with Ageless/Wellness Medicine? While we aren’t required to make an annual wellness appointment with our doc; it’s a great idea! A wellness appointment gives patients the chance to actually talk to the doc about things important to them. It lets the doc see the side of you that isn’t concerned with recovering from an illness. It lets the doc meet the real you!

Your assignment, if you choose to accept it, is to take a look at your personal wellness from a pilot’s perspective. Bad habits that need to be cleaned up in order to pass your next physical? Diet issues (include both type of food and amount)? Not enough time spent maintaining mental and personal health? Pilots invest both time and money in attaining and maintaining their ability to fly. Isn’t it time that you invested in yourself?

 

 

 

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He enjoys taking care of pilots because they aren’t quite right in the head either. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

 

Atypical Patients?

Occasionally I see a patient that asks about the “typical” patients seen by my practice. Easy question, difficult answer! While many aesthetic medicine practices have cut and dried protocols where patient X will get treatment protocol 1 and patient Y will get treatment protocol 2, my practice is different.

I believe that treatment should be individualized to the patient. Everyone is different, and thus must be treated differently. Although I make exceptions for teeth whitening, microdermabrasion, chemical peels, and Botox; I see approximately 95% of the patients that come to my practice personally prior to any treatment occurring. During the initial no-charge consultation several different things occur. Everyone gets wellness counseling up front.

My wellness counseling includes discussions on healthy diet, appropriate use of supplements, smoking cessation, and counseling on sunscreen use. Interesting new data published June 4, 2013 in the Annals of Internal Medicine showed that “The daily sunscreen group showed no detectable increase in skin aging after 4.5 years.” Wow! DAILY sunscreen use really works! Note the emphasis on daily use- the same study showed an increase in skin aging in the “discretionary sunscreen” group.

I screen our potential patients to ensure that their expectations are reasonable and they want to achieve a natural, younger look. Occasionally I will screen out patients that are looking for a “done up, Hollywood” look. I discuss different treatment options while ensuring the patient understands that doing nothing is always an option. Once the patient has reviewed the options and had a chance to consider different ways to treat their specific issue, we can get them scheduled for a procedure and be confident that they will see definite improvement in their area of concern.

We always schedule Botox or Xeomin patients for a two-week follow-up appointment to ensure they have achieved the desired results and “top them off” at my cost if we haven’t achieved their desired results. Dermal fillers like Radiesse, Juvederm, and Belotero give instant results, although I do recommend a follow-up appointment to assess the effects after the filler has settled in. Bladeless facelift (combination ablative and non-ablative laser resurfacing) patients return to the office during the week following the procedure to monitor the healing process as well as the results before they return for complimentary Radiesse and Juvederm dermal fillers.

Aesthetic treatments have to be individualized to each patient. It would be easy to treat each patient with the same amount of Botox, filler, or laser energy, but the cookbook approach just doesn’t work well with my “atypical” patients. It takes more work to consistently deliver our results, but I believe it’s worth it. Doing the right thing for every patient, even when it isn’t convenient, is what allows me to sleep well each night. If you haven’t visited my practice before, stop by and check us out during our Open House on July 20th!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He enjoys practicing atypical aesthetic medicine in an atypical community. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Doctor’s Orders

My last article mentioned that women should have sex an average of three times a week to maintain vaginal health- doctor’s orders. I have received a lot of feedback from both sexes. Most of the men have said the article was superbly written and I’ve heard of at least one husband that clipped out the article and placed it on the refrigerator. Response from the women has been a bit mixed. There hasn’t been an argument against the logic or data that supports maintenance of vaginal health. Instead, most women would like their hormones fixed prior to embarking on a journey to vaginal wellness. (Quite a few of the women have been referring to fixing their man’s hormones…) Regardless of the gender, I always appreciate reader feedback and it is very gratifying to hear that at least some of my advice is heeded.

“Doctor’s orders.” I’m a third generation physician. My life experiences have led me to practice a bit differently than my predecessors. My grandfather’s generation- “I’m the doctor and you are the patient. If you have questions please keep them to yourself. Follow my orders exactly and you will get better.” My dad’s generation- “I’m the doctor and you are the patient. If you have questions I will be happy to entertain them. Follow my orders exactly and you will likely get better.” (Notice the progression to more patient centered medicine as well as the acknowledgement that medicine doesn’t always cure.) Not so much my generation, but the way I believe medicine should be practiced- “I’m the doctor and you are the patient. I will do my best to answer your questions in a way that you can understand. I will provide you with the necessary resources to learn more and together we will come up with a plan.”

What kind of crazy new age medicine is this!!! A patient gets to participate in developing a treatment plan? Let’s face it, folks. I can spend hours developing a treatment plan. If the patient doesn’t agree with the plan they will either tell you that it won’t work or they will nod politely and disregard everything they don’t like. Why waste time developing a plan that won’t work due to implementation issues? Instead, I prefer to spend time educating the patient and providing resources so that we both come to the same conclusion. Medicine has changed, patients have changed, and we, as physicians, need to change as well.

A closing anecdote- I recently ran into a patient at a social function. “Doc, I’ve lost 10 pounds without trying since you started me on this “new” thyroid medication and I feel great! I would still like to see some improvement in my sleep though, because the bioidentical progesterone just isn’t working anymore.”

Long story short- her sleep had improved and she asked if she could take progesterone in the morning because it was easier to remember. My wife and I both prescribe progesterone to help sleep. It works better to help sleep when taken at night! Give your doc the benefit of the doubt- if you decide that you are going to alter or adjust the doctor’s orders, be prepared when things don’t work the way they should. Talk to your doc! Make sure your plan and theirs are at least compatible if they aren’t identical.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He enjoys practicing crazy new age medicine because it works well with the local population. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Let’s Talk About Sex, Baby; Let’s Talk About You and Me!

Regular readers will recognize that I am close to plagiarizing a recent article title used by my wife when she wrote about HPV in the third article of the Data Driven Docs series. I have her permission to follow her idea with this title. That said, perhaps she should be writing this article as well, for it deals with a common symptom she encounters during her well woman gynecology visits- the dreaded vaginal dryness! Men? You’d best read on if you know what’s good for you. Your sex life may be at risk if you don’t!

Business Wire dated April 24, 2013… Research and Markets reports on the study “EpiCast Report: Postmenopausal Vaginal Atrophy – Epidemiology Forecast to 2022″. According to the article: “This new report found that up to 50% of post-menopausal women experience symptoms of vaginal atrophy, but only a quarter of these individuals seek medical treatment, and cultural and social attitudes toward sexuality and aging play a huge role in this.”

The authors of the study predict that based on the increasing population age, the numbers of women that experience symptoms of vaginal atrophy will increase by 1.45% per year! Vaginal atrophy? What does that mean? As age increases, hormone levels decrease. As testosterone and estradiol levels decrease, vaginal tissue becomes atrophic (thinner, more fragile, dry). Ouch! Sex suddenly hurts.

Men, pay attention. My wife gives this advice in hushed tones behind closed doors in her office: “Women need to have sex three times per week to maintain vaginal tissue health.” That’s right! If you don’t use it, you lose it!

Doctor’s orders, honey! Honest! I’m only looking out for your well-being! We should have sex tonight because it’s almost the weekend and we’ve only had sex once this week! Guys- this actually works. Trust me – coincidentally (or not), this article was written over a two day time period. You do the math! Gals- Don’t get me wrong. I’m not advocating that you visit Win-Place-Show when your guy is out of town to ensure you maintain your vaginal health. It’s called make-up sex!

Gals- the study cited above is even more interesting when you consider that the majority of the women surveyed lived in Europe. Approximately 50% of women report symptoms of vaginal atrophy, but only one fourth seek treatment. European women are much more open about sex than we are. Based on a survey of my bioidentical hormone replacement patients, 99% not only experience these symptoms but are willing to report them if asked.

Social mores or not, sex is an extremely important part of a relationship. We need to be comfortable talking about sex with both our partner and our doc. If your doc isn’t comfortable talking about sex it is difficult to make the conversation work. My dad is an OB/Gyn and I married one. I grew up hearing about uteruses (uteri?) and vaginas at the dinner table; a line of conversation that continues to this day!

Tired of feeling tired all the time? Hormone levels out of whack? Vaginal atrophy symptoms? No zip behind the zipper? Talk to your doc or stop by and see me. I experienced low testosterone at the age of 40 and started doing bioidentical hormone replacement therapy in my practice because I wasn’t willing to continue the status quo. Take care of yourself!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He might not be able to fix everything but he can certainly help your sex life. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Data Driven Docs- Part 5: The Checklist

The Data Driven Docs article series has centered around patient safety and ensuring the actions of physicians and other healthcare providers (HCP) meet standards of care. Here is the long awaited patient safety checklist. Feel free to cut out a copy and take it to your next appointment!

Before your appointment:

I made my appointment with an accurate description of the problem(s) I want to address. (All of them… If you have any problems listed, the appointment shouldn’t be for a wellness exam).

If my appointment is for a problem, I have written down my symptoms, the timing and onset, and what I have done to try to make it better. (Include info/results from other docs or healthcare providers if you can.)

I have a written list of my medications, supplements, and surgeries that I will bring to my appointment.

During your appointment:

  • My doc/HCP is aware of the studies on bacterial transmission via clothing and wears a bow tie or tucked in tie. His sleeves (if present) are rolled to mid-arm.
  • I observe my doctor washing or sanitizing their hands prior to touching me. If not, I ask if they have!
  • My doctor looks at and discusses my vital signs with me. If I am obese or overweight, she counsels me on weight loss. If I am a smoker, he counsels me on smoking cessation and asks me about a quit date.
  • My doc/HCP addresses the problem(s) for which I made the appointment.
  • I understand the explanations and instructions or ask for clarification.

After your appointment:

  • I receive a written or verbal report of any tests or procedures ordered. If not, I call the office to request the results.
  • I follow my doctor’s instructions.
  • I make a follow-up appointment as necessary and plan to keep it.

Checklist or no, please keep the above bullet points in mind at your future appointments. Do your homework before your appointment. Hold your doc/HCP accountable for wellness counseling and follow their advice. Above all, get involved in your healthcare. Our medical community depends on your involvement for survival!

 

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that the quality of healthcare will decline as long as the community fails to get involved. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

 

Data Driven Docs- Part 4

The Data Driven Docs article series has previously discussed three different issues dealing with ensuring that the actions of physicians and other healthcare providers meet standards of care. This article will address patient safety in a unique way by looking at the healthcare team.

Representatives Bucshon (R-In) and Scott (D-Ga) introduced a bill entitled “Truth in Healthcare Marketing Act of 2013” (HR 1427) on April 9, 2013. The intent of the bill is to clarify who is and who is not a medical doctor. According to the April 24, 2013 Medscape Medical News article,  “The bill would make it illegal for any healthcare professional to make false or deceptive claims in advertisements and marketing materials regarding their training, degree, license, or clinical expertise. Anyone marketing a health provider’s services also must clearly state the license the provider holds.”

Wait! Is this really necessary? According to two surveys referenced in the bill it is. Approximately 50% of patients polled in both surveys either identified chiropractors and psychologists as medical doctors or stated they didn’t know the difference.

Physicians/medical doctors in the United States will have either MD or DO listed after the last name. The degree of either medical doctor (MD) or doctor of osteopathy (DO) is earned after completing twelve years of primary education, four years of undergraduate education, and four years of medical school. All physicians must now complete residency training to be eligible for board certification. Residency training adds an additional three to seven years depending on specialty.  Fellowships tack on one to four more.

So, graduating from high school is only the halfway mark to becoming a doctor? Ouch! It is definitely a long road that few choose. As physicians, we receive additional training to ensure that we are experts in our field. As an anesthesiologist, I have had the honor of putting patients to sleep for heart transplants. It is humbling to be able to take someone that is clinically dead and bring them back to a better lifestyle than they had prior to surgery.

Can physicians practice medicine today without help? Emphatically NO! We are celebrating Nurse’s Week as I write this article. The safe practice of medicine requires a team approach, now more than ever. Nurses are an essential interface in patient care. I’ve previously written about how patient safety can be compromised without support from kind and compassionate nurses. They are often required to perform dirty jobs and never receive enough thanks. (Celebrating nurses all year would be more appropriate but would lose the impact.)

Rural medicine couldn’t function without the tireless effort from our poorly recognized mid-level providers. Our small community relies on Nurse Practioners to provide patient centered care within the community. All of Lincoln County Medical Center’s outreach clinics are staffed by Nurse Practitioners. We ask them to serve as the pediatricians, family practitioners, internists, gynecologists, and ER docs for our outlying areas. PTSD anyone? National Nurse Practitioner week is in November, folks. Mark your calendars!

Medicine is a group effort. Providing safe, quality care can only be achieved when all parts are working correctly and in harmony. Your part? As the patient YOU are responsible for ensuring that the healthcare system functions appropriately. To do this, you need to be educated about your medical conditions, your healthcare providers, and the local healthcare system. You need to hold us as healthcare providers accountable for the patient care we deliver. We need to drive our healthcare system toward increased efficiency, increased patient safety and decreased cost. The final article in this series will provide you with a clip-out data driven checklist you can take to your medical appointments. Stay tuned!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that the quality of healthcare will continue to decline as long as the community fails to get involved. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Fusion Medical Spa