How To Find A Provider

So now that you know how to choose the right doctor (or other provider), how do you find one? That can be difficult. I was lucky. I found the first anchor of my network on TV. He was on a local news segment talking about inhaler insulin back when we thought that was going to be the next big thing. And he worked in a university clinic, which meant that he took my insurance.

If you already have a doctor you like, finding another one in a different specialty is a little easier than if you don’t. Ask for a referral. Doctors generally have extensive networks: colleagues, classmates, partners. It’s not always a match, but if you like your doctor, and your doctor thinks highly of another medical professional, there’s a good chance that person will be a good fit.

That’s what I did when the aforementioned doctor moved on. After over a decade, I was in his office trying to connect him with another provider (I thought they could help each other). That’s when I found out that he was only going to be in practice for another three weeks. He was leaving for a big drug company, which made sense since I knew his heart was really in research, but didn’t help my state of mind. I was upset, and a little shocked. I am so resistant to change. Anything that shakes my comfort zone requires tons of advanced notice and a lot of time to mentally prepare. Thank goodness there are months between visits! I asked for a recommendation, and when I couldn’t get an appointment because she wasn’t taking new patients, he was kind enough to make a phone call to get me in the door.

Then there was the time my specialist got tired of treating me for every cough and sniffle. He knew how particular I was about my doctors, so he gave me the name of his General Practitioner. The theory was that if the General Practitioner was good enough for my doctor, he was good enough for me. Fair enough, but I waited. And waited. And waited until I really needed a General Practitioner, and knew that my specialist wouldn’t see me for the flu. By the time I called for an appointment, the doctor whose name I’d been given had retired. (That’s typical for me.) I was desperate, so I went to see the doctor who had been hired to replace him. Lucky again—it turned out to be a great fit! So good, in fact, that I drive 25 miles through two states and the District of Columbia to see him.

But maybe you’ve just moved or you haven’t been to a doctor for a while, or the one(s) you have don’t fit as well as you would like. What then? Where to start your network?

Do your research. If you live close to a university like that has a medical school, like Johns Hopkins in Baltimore, MD, or a big research center like the Mayo Clinic in Rochester, MN, or the Cleveland Clinic, in Cleveland, OH, start with their staff. The doctors there are on the cutting edges of their specialties, and often take new patients.

If you don’t have a resource like that or it is too far away, I recommend starting with a site like healthgrades. Decide what is important to you. Considering the following factors may be helpful:

• Board certification
• Education
• Residency
• Years of experience
• Location
• Whether they take your insurance
• Past or pending malpractice claims

Don’t forget to read the crowdsourced reviews, too, but be sure to take them with a grain of salt. Often those who take the time to comment are the ones who had experiences at the fringes of the satisfaction scale: they are either very pleased or completely put off. Likely the majority of patients are happy enough but haven’t taken the time to post a review.

When you are satisfied that you have the information you need, rank your top three candidates. Make an appointment and you’re ready to go!

How to Choose a Provider

One of the most important things in my medical life is the team of providers I have assembled. I am very particular about those I have selected to help me navigate my condition. You should be too. These are the people who enable your life. Literally. I owe it to myself to invest at least as much time researching and interviewing medical providers as I do business partners or mechanics.

For me, the one attribute all my providers must have is the capacity to accept that they are not the only authority. We share that responsibility. My doctors consult each other, whether they are in the same office or not, and they welcome me as an equal partner and contributor. This may not be the right formula for everyone. For example, my father prefers for his doctor to remain THE AUTHORITY.

Either way, it is important to get what you need from your appointments, to feel like you leave with all of your questions answered and with the tools you need to flourish in the months in between.

The first step toward finding the right provider is to make a list of what you are looking for. Education and residency may be important to you, communication style, availability, or length of time the doctor has been practicing. Or recommendations from people you trust. Treat it as if it were a business interview. List your questions and have in mind an acceptable range of answers for each.

Second, decide your priorities. You may want to sort your providers into different categories. What I mean is, there are providers you see once a year and providers you see once a week. There are the ones to see for chronic conditions and the ones to see for more mundane issues. I choose to invest the most effort in finding those who will treat conditions that have the potential to cause the most physical damage. Oh, and my General Practitioner. You may feel like you see enough doctors, but an Internist or General Practitioner is also an important part of your team. Generally speaking they are a lot easier to schedule than specialists, who are usually booked solid months in advance. And you will need one, not just for those pesky, unavoidable events like getting the flu, but also to be a sort of ringleader, someone who gets all of your files from all of your providers, and can help you keep track of all the things that may fall through the cracks.

Lastly, don’t be afraid to shop around. Many people go to a doctor who isn’t a good fit and still return for the follow-up visit. This may be because they don’t have time to search for another doctor on their plan, or because they feel a kind of obligation to return, or any number of reasons. If your mother was anything like mine, she told you that you shouldn’t settle. If that advice is good for a date, it’s good for a doctor.

Good luck assembling your team!

Your Life as a Car

This blogpost is by Debra Hein. Debra is a Personal Trainer of over 25 years, specializing in people with conditions (diabetes, cancer, heart disease, etc.). She has a Bachelor of Arts in Exercise Science and is a Certified Exercise Physiologist (CES), Certified Personal Trainer (CPT), and American Heart Association Certified Instructor. Deb is my trainer. She can catch fluctuations in my blood sugar before I do.

I have spent hours trying to start this article so it would not be just another article about the importance of exercise, disease prevention, and health. As a trainer, I have always used the analogy of a car engine and your muscle mass to describe burning calories. The larger the car engine (muscle mass), eight cylinders vs. four cylinders, the more gas (calories) you burn to travel the same number of miles. Expanding on this will show the effects of a sedentary lifestyle on the human body.   

Think of your body as a shiny new car – your choice. I will use one of my favorites, a 1957 corvette. Let’s set up the analogy to the human body with a list of parts:

• Car: human body
• Gas pump/carburetor: human heart
• Hoses and fuel lines: arteries, veins and lymphatic system
• Gas, oil and other fluids: blood, lymphatic fluid and food/nutrition
• Number of engine cylinders: muscle mass
• Engine/computer system: brain
• Driving: exercise
• Mechanic: doctors  

Sixty years ago, this was a brand new car with a clean engine, new tires, and a pretty new paint job. It ran like a dream, and the owner was happy to drive it every day. By driving the car every day (exercise), the engine (brain) would get the gas, oil and other fluids (blood and bodily fluids) pumping through the car (body) to move the cylinders (muscles) and make the tires move the car. Everything would work well if the owner made sure the fluids were kept clean, gas tank was filled (nutrition), and the car was brought in to the mechanic (doctor) for regular tune ups. Rarely did the corvette need to go to the mechanic (doctor) for more than regular visits (annual checkups). 

As the years passed, the owner’s needs changed, family size grew, and this shiny new car spent more time in the garage (sedentary). The car was not driven (exercised) every day, and soon, things began to break. The battery (motivation) died and had to be replaced. Once the car started, she ran well, but there seemed to always be something that needed to be checked. Annual tune ups were no longer good enough.

By now, the corvette had logged thousands of miles; hoses and tires needed to be replaced, and other parts began to show wear (signs of aging including sports injuries, etc.). The paint became a little dull (body added a few pounds) and didn’t quite have the sex appeal as in years past. Trips to the mechanic became more common because of age issues with the car.

Eventually, to keep the car on the road, expensive replacement parts needed to be found. The type of fuel used when the car was new was no longer available and special additives (drugs) were needed in order for it to run properly. The end of the corvette’s days was slowly approaching. The lack of use (exercise) was too much and the gas/fuel pump and lines rotted (atherosclerosis). The car needed a whole new engine. At that point the cost of upkeep became very high (increasing medical cost of aging).

This is what happens to your body over time. 

Study after study shows the importance of movement and activity in our lives. Not only for weight control, but for heart health, brain activity, muscle function and strength, controlling our body functions, and overall wellbeing. See below for a table on common diseases and the impact exercise can have to help prevent, postpone and control symptoms and responses. Just like cars, our bodies are born to run. 

Disease/condition	Recommended cardio activity	Type	Recommended strength activity	Benefits/responses
Coronary Heart Disease (CHD)	>3 mph (40-80% HR) 30-60 min 5-7 days/wk *	Rhythmic large muscle groups	2-3 days/wk Each major muscle group 30-40% 1-RM^ for upper 50-60% lower exercisers *	- Improves aerobic capacity - Increases muscular strength - Lessens of angina symptoms - Raises ischemic threshold - Improves endothelial functions
Hypertension High BP	>3 mph 30-40 min 5-7 days/wk		Use caution for heavy lifting and isometric resistance exercises 60-75% 1 RM 2-3 days/wk All major muscle groups	- Reduces Systolic BP^^ 4-9 mmHg - Reduces weight, which results in additional SBP reduction - Reduces vasoconstriction - Reduces peripheral vascular resistance
High Cholesterol Dyslipidemia	40-75% HR		40-70% HR***	- Reduces LDL 4-7%^^^ - Increases HDL 4-25% ** - Reduces adipose fat
Pulmonary Disease	Start with 3-5 days/wk working towards 5 days/ wk Intensity will be individually determined based on individual’s response.		2 days/wk Individually determined based on individual’s response.	Depends on disease, severity and individual responses
Diabetes	5+ days/week	Varies for Type I and Type II	2 days/week Varies per individual	- Enhances insulin sensitivity - Increases cardiovascular fitness - Improves glycemic control
Arthritis, Osteo and Rheumatoid	3-5 days/wk 30 min or more Intensity varies by Individual.	Rhythmic large muscle groups – walking, cycling, water workouts ++	2-3 days/wk working all major muscle groups – 8-15 reps Yoga/Tai Chi++ Intensity will be based on individual level+++	- Improves range of motion, flexibility, aerobic endurance, muscle strength+++

Please note:

^Repetition maximum (RM) is the most you can lift once. So, when it says 30-40% 1-RM, that means for your set of weightlifting, you should use a weight that is 30-40% of the most you can lift once. 

^^Systolic blood pressure (SBP) is the bottom blood pressure number.

^^^LDL is bad cholesterol. HDL is good cholesterol.

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Sources:

*LaForge, R., M.S. (2015). Coronary Heart Disease. In Medical Exercise Specialist Manual (p. 202). San Diego, CA: American Council on Exercise

**LaForge, R. M.S. (2015) Blood Lipid Disorders, in Medical Exercise Specialist Manual (p. 224) San Diego, CA: American Council on Exercise

***Galati, T., M.A.  (2015). Applying the ACE Integrated Fitness Training Model in The Medical Exercise Setting In Medical Exercise Specialist Manual (p. 50). San Diego, CA: American Council on Exercise

$ LaForge, R., M.S. (2015). Coronary Heart Disease. In Medical Exercise Specialist Manual (p. 188). San Diego, CA: American Council on Exercise.

$$ Kenney, W.L., Ph.D., & Alexander, L.M., Ph.D., (2015). Hypertension in Medical Exercise Specialist Manual (p. 254, 259, 264). San Diego, CA: American Council on Exercise

+ Riddell, M., PhD, & Perkins, B. A., M.D., M.P.H., FRCP. (2009). Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring. Journal of Diabetes Science and Technology From Basic Science to Clinical Practice, 914-923. Retrieved March 11, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/.      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/ 

++C. N. (n.d.). How to Start an Exercise Program. Retrieved March 12, 2017, from http://www.arthritis.org/living-with-arthritis/exercise/how-to/starting-exercise-program.php

+++ Aronen, J.G., M.D.,FACSM & Lorenz, K.A., Ph.D., CSCS, NSCA-CPT, (2015) Arthritis in Medical Exercise Specialist Manual (p 544). San Diego, CA. American Council on Exercise