Thursday, November 13, 2008
By Anthony Policastro, M.D Military personnel and their dependents do not have to pay for outpatient care at military facilities. Whether they have an office appointment or an ER visit, there is no charge. The people who worked in my ER's often complained to me that patients overused the ER because of that. For that reason, I offered them a challenge. I asked them to find for me someone that they thought was overusing the ER. If they could, I would address it with the patient directly. Two things happened as a result of that challenge. The first was that they did not often come to me with any names. They did indeed see some people more frequently than others. However, when they looked at the reasons for the patients being there, they found that most of the reasons were legitimate. Therefore, those patients used the ER more often because they were actually sick more often. The second was related to the review I did when they did identify a patient to me. Since both ER and outpatient visits were all part of the same system, they were recorded in the same computer system. When I got the name of a patient, I looked up the name in the computer. I found the same thing in every instance. Every patient that used the ER frequently had a large number of office visits as well. They were not just using the ER. They were utilizing medical care in all areas. In most cases these patients were not a lot sicker than other patients. They just had a low threshold for seeking medical care. There is usually not one reason for this kind of behavior. In some cases, patients see the physician a lot because they do not have a lot of medical knowledge. They think they need to be seen when that is not actually the case. This has nothing to do with intelligence. Some people worry more about their health than others. They want to be reassured that everything is OK. Some people worry about their children and think that they need to be seen for every minor childhood illness. In either case, it is important for the physician to help educate them. For example, I have a standard talk that I give to mothers at the four-month check up. I tell them that their child is losing the immunity that he/she got across the placenta before birth. That means that the child will start coming down with infections every two weeks or so until they hit two years of age. A majority of them will be minor. Some will have very few symptoms. Most will last 72 hours and then go away. For that reason, childhood illnesses with minor symptoms like fever should be treated for 72 hours for those symptoms. If the child gets better, then the infection has run its course. If the child does not get better, then an office visit is usually warranted to see what is the cause of the prolonged illness. Patients would then have a little more patience treating their children when they got sick. Another reason for frequent visits for medical care is the mistaken belief that every illness needs medication. I still receive phone calls from parents asking me to call in an antibiotic because their child is ill. Most illnesses do not require an antibiotic. Before the time of antibiotics most illnesses resolved on their own. This kind of belief by patients also requires education by the physician. If a patient does get better without medication, it will help them understand that drugs are not the answer to every illness. Some heavy users of medical care do so because they read about their symptoms and always think the worst. Therefore, they want to be reassured that they do not have a serious illness. They will go to the doctor to be checked for that serious illness. Unfortunately, they do not tell the doctor what they are worried about. Therefore, the doctor does not mention that particular disease. They leave thinking the physician has missed something. So back they go to make sure they do not have that serious illness. It is important for patients to tell physicians if they are worried about having a particular illness. Physicians will not always be able to guess at what the patients are thinking. The question needs to be asked specifically. These are just some of the reasons that patients seek a lot of medical care. In most instances improved communication between the physician and the patient will help decrease the high number of visits. The responsibility for that communication falls on both individuals. It needs to involve more than just the reason for that particular visit.

Nanticoke raffles game system The Look-In Glass Shoppe at Nanticoke Memorial Hospital will raffle a Wii gaming system console that includes a CD with five sports games, two nunchucks and two remotes (retail value $350). Tickets are on sale at The Look-In Glass Shoppe (located within Nanticoke Memorial Hospital) from Nov. 14 until Dec. 15 at noon. Tickets cost $5 each or five for $20. The drawing will be held at noon on Dec. 15. All proceeds from The Look-In Glass Shoppe benefit Nanticoke Health Services. For more information about the raffle, call 302-629-6611, ext. 4955.

Hospice needs volunteers Hospice patients and their families need volunteers to read to patients, run errands, offer companionship and/or provide relief for caregivers. Training is provided by Compassionate Care Hospice. An information session will be held at Seaford Presbyterian Church located at 701 Bridgeville Road on Tuesday, Nov. 11 from 10 a.m. to noon. A Compassionate Care Hospice representative will be available to answer questions. The session will be held in the lower level of the church. For more information, contact Volunteer Coordinator Susan Graves at 302-934-5900. Stroke and Osteoporosis Screening Life-Line Screening will be at the Nanticoke Senior Center on Dec. 10. The site is located at 310 Virginia Ave. in Seaford. Appointments will begin at 10 a.m. Screenings are non-invasive. They help identify potential health problems such as blocked arteries and irregular heart rhythm, abdominal aortic aneurysms, and hardening of the arteries in the legs, which is a strong predictor of heart disease. A bone density screening to assess osteoporosis risk is also offered and is appropriate for men and women. Register for a Wellness Package with Heart Rhythm for $149. All five screenings take 60 to 90 minutes to complete. For more information regarding the screenings or to schedule an appointment, call 1-877-237-1287 or visit us on the web at Pre-registration is required.

Prostate Cancer Screenings If you're a male over 50, you're at risk for prostate cancer, the most frequently diagnosed cancer in men and the second leading cause of cancer death in men. And if you're African-American, your prostate cancer mortality rate just doubled: you should get screened beginning at age 40. Bayhealth Medical Center will offer free prostate cancer screenings on Saturday, Nov. 15 from 8 a.m. to 11 a.m. in the Kent General Endoscopy Suite. Bayhealth's free two-part screening includes a blood test for prostate specific antigen (PSA) and a digital rectal exam (DRE) performed by a urologist. Attendees must pre-register and qualify to participate in the screening. To register, call 302-744-7135, or (toll-free) 1-877-453-7107.

Gold Coast sale Shop early for the holidays in the lobby at Nanticoke Memorial Hospital on Monday, November 17, 7:00 am to 4:00 pm and Tuesday, November 18, 7 a.m. to 3 p.m. The Look-In Glass Gift Shoppe at Nanticoke Memorial Hospital is hosting a "Gold Coast" sale featuring rings, earrings, watches, pendants, and bracelets with diamonds and in gold and silver. All proceeds from The Look-In Glass Gift Shoppe benefit Nanticoke Health Services.

Cardiovascular Disease Screenings According to the American Heart Association, there are an estimated 80 million people in the United States with one or more forms of cardiovascular disease (CVD). To give patients easier access to care, Bayhealth is offering low-cost CVD screenings at several local physician offices. Screenings will include checking blood pressure, cholesterol (total lipid profile and ratio) as well as a glucose evaluation. Fasting is not required. Screenings will be available at the following locations:
November 13, from 9:30 a.m. - 11:30 a.m. at the office of Dr. Morris and Dr. Gupta, located at 305 Jefferson Ave., in Milford.
November 14, from 9:30 a.m. - 11:30 a.m. at Bayhealth Women's Care Associates located at 517 S. Dupont Hwy., in Milford.
November 14, from 1:30 p.m. - 3:30 p.m. at the office of Dr. Sargent located at 25 Bridgeville Rd., in Georgetown.
For more information, contact Donna Goldsborough at 302-744-6144.

DPH offers free flu shots The Delaware Division of Public Health (DPH) will offer free flu shots to everyone six months of age or older at a flu clinic in Dover on Wednesday, Nov. 19 from 10 a.m. to 6:30 p.m. at the Modern Maturity Center.DPH will provide 2,500 flu shots. Staff will provide car side service to clients who cannot walk into the center. The Kent County flu clinic is organized as a preparedness exercise so DPH can test its mass vaccination capabilities needed in an influenza pandemic. This event mirrors a successful flu shot exercise held last November at the Delaware Technical Community College in Stanton, where the triaged public received 2,544 flu and 84 pneumococcal vaccinations in 9 hours.