Medical Malpractice

The care of the person with a thyroid disorder in today's healthcare environment is inefficient at best and is worthy of malpractice at its worst.

Let me explain.

The vast majority of thyroid problems are underproduction of thyroid hormones by the thyroid gland.

It is estimated that approximately 1 in 10 people you meet has a low functioning thyroid gland which is called hypothyroidism. The symptoms of a low thyroid output can be global as the thyroid hormones determine the basal metabolic rate of all cells in the body.

What does that mean?

It means that the rate at which your cells respire, take in nutrients, pump out waste products is determined by how much thyroid hormones you have any any one time in your body.

Low thyroid hormone amount in your bloodstream= slowed down ability to function.

This affects everything: speed of digestion, speed of cognition, speed of recovery, etc, etc. This is why hypothyroidism can have symptoms like brain fog, depression, constipation, unexplained weight gain and coldness.

There are 2 predominant models in today's healthcare environment: medical and alternative.

In the medical model, no thought is given to why a persons thyroid is not functioning well, the only treatment is to give thyroid replacement hormones until the message from the brain to the thyroid which is called thyroid stimulation hormone or TSH, is normalized usually at a value of about 2-3.

The alternative model for hypothyroidism is not about thyroid hormone replacement, it is instead fixated on iodine and tyrosine supplementation to allow the thyroid to make more thyroid hormones.

Additionally, thyroid glandulars and co factors are added to insure no nutrient deficiency exists for thyroid production.

Here is the problem.

Over 80% of all hyothyroid patients do not have a nutrient deficiency of iodine or tyrosine as their mechanism for low thyroid production. And, just giving thyroid hormones does nothing to counteract the basic mechanism that is in play for about 80% of all hypothyroid patients.

What is the mechanism?

It is an auto immune attack by your own immune system on your thyroid! This means that a gene in your body got switched on that tells your immune system to tag the thyroid gland for destruction.

When the immune system ramps up for for an auto immune attack, certain cell messengers called "cytokines" are released. These cell proteins or" cytokines" completely interfere with many aspects of thyroid physiology.

So, lets see how this information fits into the alternative and medical model.

The alternative model will try to get the thyroid to make more hormones by using nutrient combinations. The medical model will not care about the mechanism, just replacement hormones.

It is known that if you introduce iodine wholesale into a community, 2 things happen:

goiters go down and auto immune thyroids go up. So, iodine supplementation in the alternative model may precipitate an autoimmune disease of your thyroid! Or, fire up an auto immunity that was already present. This is definitely not the intended result.

In addition, if the mechanism for the low thyroid is autoimmune, giving iodine does not do anything to dampen the levels of cytokines in the body.

In the medical model, since the thyroid gland is being destroyed by the immune attack, thyroid hormones are prescribed. And while this may help a bit in the short term, it doesn't address the way the thyroid hormones are interfered with by the autoimmune messengers called cytokines. Therefore, you can have a person whose thyroid blood test looks normal but are experiencing many of the symptoms of a low thyroid person because the expression of the thyroid hormones is compromised by cytokines.

Neither approaches come close to helping the person resolve the symptoms associated with hypothyroidism.

Here is what does help.

Dampen the autoimmunity!

When you reduce the auto immune expression, you dampen the amount of cytokines, you improve thyroid physiology.

It's that simple.

Or, at least in concept it is simple. The real work in all of this, for me is to figure out the person's autoimmune triggers, and discover which sides of their T helper system to support. And if person needs thyroid hormone replacement, so be it. By the way one of the most profound triggers for flaring up autoimmunity is eating gluten and all of the other foods that cross react with it.

This approach has a profound effect on the quality of a hypothyroid person's life.

Now they have a way to decrease brain fog and weight, increase energy and motivation, have normal temperature, skin, hair and digestion.

Here is the final kicker: If a person had antibodies to the thyroid, there is over a 50% chance of them demonstrating antibodies to other tissues. These tissues can include nerve (MS), organs (lupus), joints (rheumatoid arthritis) and even brain tissue. Even hormones themselves can have an antibody reaction.

If the immune system flares up to tag the thyroid for destruction, what is happening to these other antibodies? You're right. They cause their own destruction of those tissues.

So, the key to most hypothyroid patients (about 80%) is to dampen their autoimmunity, not just give thyroid replacement hormones or a single nutrient to resolve their symptoms.

So, how do you do that? I will address that in a future e-mail.

Recognizing and treating the neuro-endocrine-immune system in about 80% of all hypothyroid patients is is the most efficient model for hypothyroidism today.

All dental care is cosmetic to a certain extent. There are different levels of cosmetic in the dental procedures. If you are looking for low cost cosmetic dental care - then a dental university would give you very good results.

Remember that having dental insurance doesn't mean that the cosmetic dental work has no fee. Insurance is liking having a coupon for the total cost. You will always have to pay your deductible.

Some people recommend going to Mexico or Thailand to get cheap cosmetic dental care. But a word of caution here. Before you go to any other country for dental work, do a lot of research. It may sound offensive, but there are lots of scams geared toward people from the States especially in Mexico, and if they know you are coming just for treatment, they will know that you will have next to no recourse.

The recent trend in medical tourism is bargain-priced dental treatments in Latin America and Asia where, according to reports, medical and dental practitioners operate modern, well-equipped clinics and centers, many of which are attached to or affiliated with resort and hotel complexes. Check online for several Asian and Latin American dental complexes that cater to American visitors. You will find that typical prices for cosmetic dental care services are around $350 to $500 for a crown, $700 to $1,000 for a full denture, and $2,000 to $3,000 for an implant.

But, again act with caution in these cases. You really don't have a legal recourse in the above countries unless you the country have strong laws to protect against negligence and malpractice.

A safer option would be to go to a university near you that has a dental program and find if they will take you as a patient. You can good quality cosmetic dental care from students and supervising professors for your teeth.

Most people these days go to chiropractors first before seeing their doctors and the reasons are obvious. Chiropractics offers practical solutions to common ailments, especially those related to neck and back pains. Of course, medical doctors will be the ultimate authority when it comes to health treatments but some people have been very comfortable with chiropractic procedures because they are quick and relaxing.

Yet even with some medical professionals actually referring their patients to chiropractors, some people remain skeptical as to the safety of this method of healing. There are those who claim that it causes strokes because of the manipulation of the neck and spinal area, a routine chiropractic procedure. However, the link has not been fully substantiated by research and those who truly understand chiropractics know that people who tend to experience strokes usually experience neck and back pains as initial signs. Hence, there is a percentage, although small, of people going into chiropractic treatment and having strokes.

Furthermore, the facts point to the conclusion that chiropractic-related injuries occur relatively less frequently than those related to medical procedures. Because of this, chiropractors pay 10-50% less malpractice rates than doctors. The number of patients getting ill from back and neck manipulation is also barely.30% of those attributed to over-the-counter painkillers and anti-inflammatory drugs. And in a span of 65 years, only 19 chiropractics-related ailments have been reported. If anything, the numbers point only to the favor of chiropractic treatment being safe and healthy. Of course, patients with sensitive conditions shouldn't undergo any chiropractic procedure unless cleared by their doctors while those who have common back and neck aches should be safe.

When it comes to effectiveness, there is no doubt what manipulation can do to relieve acute or chronic back and neck pains. Binding spinal joints can be such a hassle and loosening them with chiropractic procedures is, indeed, the answer. In fact, what chiropractors do is very similar to to what physical therapists, osteopaths and orthopedists perform on their patients. In the US alone, studies show chiropractors do 94 % of such procedures which means it is a widely accepted alternative to the medical approach. Missouri, for example, has many practitioners, from St Louis chiropractors to those in Chesterfield, Maryland Heights, Creve Coeur and in many other locations. This only adds proof to the thousands of studies that have indicated higher patient satisfaction obtained from chiropractics than any other method of treatment.

Is Having a Professional Coach a Solution to Optimizing your Practice's Performance?

"What do you do?"

The proverbial question we get asked day in and day out by strangers, acquaintances, family, and friends. We are conditioned to answer with our current job or career.

Thanks to an anticipated, planned for and welcomed career change, my new answer is some version of "I am a professional coach."

And the standard response back is, "Really, for what sport?"

"The game of life,"

I say and then the conversation either stops in its tracks, or takes off to some very interesting place.

And in the ensuing conversation, I tell them about this relatively new profession called "coaching" which most often has an adjective in front of coaching such as life, professional, executive, business or other such phrases that identify the coach's niche.

I appreciate the opportunity to have this conversation with you via this newsletter, and hope the information shared will tell what a coach is, and how enhancing your coaching skills or engaging a coach might help improve the performance of your medical practice, and might even be a solution for helping your disgruntled, irritable, difficult to get along with physician, or perhaps the "newbie" physician who is awestruck with the transition from residency.

"What is a coach?"

A coach is your champion; partner; advisor; guide; counselor; consoler; touchstone; personal listener; confidante; teacher or as one coach puts it, "the gardener of your mind." A coach helps you enhance the quality of your professional and personal lives, and reach peak performance and your ultimate potential.

So as you can surmise, coaching is a dynamic process of discovery, growth and development. Coaching creates an environment where there is freedom from judgment and from expectation, yet one of accountability and growth. In a coaching relationship, it is safe to question, appear vulnerable, observe, explore, experiment, learn and change. The process is designed to ensure lasting change and promote continuous growth.

In the hectic, demanding world of health care, professionals and leaders must find a way of staying on top of the surf, so that they are not sucked down and out by the riptide. A coach helps his client ride the wave, navigate through the rough waters, and enjoy the ride. There are so many reasons for physicians to feel disenchanted with their chosen profession, their calling. Having a coach helps them get back in touch with their passion for being a healer.

"So, a coach is like a therapist?"

Therapists typically work with people who need help becoming emotionally healthy. They deal with past issues and how to overcome them. So therapists tend to work with dysfunctional people to get them back to functional. Coaching is action oriented. It is about achieving growth through identifying and reaching goals, rather than by working through past issues. So a coach helps people go from functional to exceptional.

Another interesting distinction is that a coach is not a mentor although a coaching relationship has some characteristics of mentoring. Most often, a mentor is someone in your company who is higher up in the organizational structure, and is bestowing knowledge upon you to prepare you for greater responsibility and upward movement. In contrast, a coaching relationship is a partnership which draws on the wisdom and the knowledge of both parties. The coach does not have an agenda other than what his client wants.

"OK, I understand, but what application does it have to my business world?"

Executive coach

is the term most frequently used to refer to coaches who work with businesses, professionals or in your case, medical practices. In essence, instead of two parties, there are three---the company, the client and the coach. The leaders of the most successful companies recognize that the attraction, development, motivation and retention of highly talented people are the biggest contributors to maximizing the company's success. They see the engagement of a coach as a proactive, positive way to help an employee, most often a manager or a professional, reach certain goals, change some behaviors, or develop specific management competencies. The employee agrees to these expectations and to working with a coach; and the employer engages the coach for the employee. The confidentiality of the coaching conversation remains sacrosanct; the employer is notified only if the employee is not participating.

In the business arena, a coach is sometimes referred to as a consultant. While there are some similarities, as importantly, there are some key differences. A consultant brings expertise, and thus answers to the proposed question or challenge. Typically, he then leaves the company with a report and recommendations to implement. A coach has expertise and answers; however, he works with you to identify the answers that will work best for the company and then stays through the implementation steps to ensure the changes materialize and the results are realized.

"So an executive coach can help me improve the performance of my people and thus, my bottom line?"

Yes, executive coaching is an investment in human capital just like traditional training and education programs. In fact, coaching and training frequently go hand in hand and studies have shown that doing so improves productivity 88% versus 22% with training alone. (Public Personnel Management, Winter 1997 v26 n4 p4610) The coaching assists his client in overcoming the obstacles that otherwise would prevent him from inculcating the imparted knowledge. Humans are creatures of habit, and we all know that breaking habits and embracing new ones is a great challenge. A coach helps us get out of our own way, so that we can reach for and accomplish greater things.

"You know in my practice, our focus is on teamwork. How does an executive coach help with that?"

Actually the principles applied to coaching individuals also apply to coaching groups or teams of people. A coach can assist a team in optimizing the communication amongst the members and maximizing the synergy of the group. As a result, performance and outcomes are maximized--which is critical in today's world of declining reimbursements and increasing malpractice premiums. Especially with teams, coaching helps shorten the learning and the doing curves, so minimizing the investment of time and expenses while optimizing results.

"Gosh, I am now thinking that I would really enjoy working with a coach."

Actually, many executives/CEOs work with coaches for they are frequently the "lone man on the totem pole". Being a practice manager means you are the "lone man," with many unofficial "bosses" -that is a huge challenge to navigate alone. Some of your physicians may feel the same way. A coach gives you someone to bounce ideas off of; express concerns and fears; brainstorm ways of handling difficult issues; role play difficult conversations; etc. Using a coach actually helps reduce your stress. Of course you have colleagues and others that assist you, but the differentiating factor for a coach is that he does not have an agenda, or a "stake in the game", and thus, is all about you.

"How do I learn more or find a coach?"

The International Coaching Federation, http://www.coachfederation.org, is the recognized organization that most professional coaches belong to. The site has more information about coaching as well as a list of coaches by area. The nice thing about coaching is that the most common medium of delivery is the phone. Majority of coaches offer a free
introductory session, and are truly interested in educating others about coaching. You can also download a handbook on executive coaching at www.executivecoachingforum.com.

Janet Crawford MBA, MHA is CEO of Tiberius Enterprises, Inc. and an Executive Coach. She has a heartfelt connection to the medical profession, having worked as a healthcare administrator and practice manager in her previous life. She can be reached at 540-342-2844 or jc@tiberiusenterprises.com, and the company's website is www.tiberiusenterprises.com.

Originally published in Virginia Medical Group Management Association newsletter, Vol. 6, No.1 Winter 2005

Cellulite formation is something that people do not want to have. Aside from the fact that it makes the skin look awful, it can also cause an irreversible defacement on the surface. However, there are some helpful and natural means that supports in preventing and alleviating cellulite.

There are a lot of ways to remove cellulite from the body. It is apparently seen with natural treatments and for others, results may come from medications. Before going for the more expensive options, please take a look at some of the natural ways to combat the occurrence of cellulites.

Anti cellulite diet

Observing proper and healthy eating habits may not be an easy task for a lot of people, nevertheless, it may possibly help in the problems about cellulite. In spite of that, the knowledge of taking in a balanced meal is not enough. People must take into consideration the food that they will include in their diet.

An individual who decides to have an anti cellulite diet should be aware of the food that are known to contain substances that efficiently fights against cellulite formation. In addition to that, one should also know what food contain stuff that speed up and aid in the formation of cellulite. This simply means eating healthy foods and getting rid of the junk foods.

Cellulite creams

Another way of getting rid of cellulites is applying creams designed to counter act this problem. These creams go deep into the skin and directly act on the problem area. They flush away toxins and unwanted fat, enhance blood circulation and strengthen the connective tissues. It should be taken note however that not all of these creams really cure cellulite.

Creams with the proper combination of anti cellulite components should be carefully chosen to prevent waste in both time and money. Although, some creams may not be as effective as others, they, nonetheless, aid in lessening the unpleasant appearance of the skin due to cellulite. On the other hand, buying creams that contain unsuitable mixture of ingredients would have no support to change your body's appearance. It would be best to check upon buying if the creams include L-carnitine, green tea, vitamin A and even caffeine.

Exercise

Exercising is one effective alternative for people who have cellulite and find it costly to go through medical treatments. However, if one decides to choose exercise as a cure for cellulite, then it should be done accurately and devotedly. You just need to bear in mind that your routine should be in coordination with your schedule because if this is broken, then the effects would not be that evident.

Combating the cellulite problem could be done in more ways than one. If the above-mentioned procedures will leave you with negative results because of malpractice, you may opt to go for the surgical treatments. Consult your doctors at once before undergoing any other medication.

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Cellulite Cream Benefits And Shopping Tips -> Cellulite Cream Benefits

Throughout Southern California and especially in Beverly Hills and Los Angeles people are inundated with advertisements about plastic surgery. Some ads depict a plastic surgeon as the "Top" or "Best Plastic Surgeon in Beverly Hills or Los Angeles". Others promote "safe Liposuction" or the newest laser that can give you phenomenal esthetic results with a few zaps during your lunch hour. With all this information how should a man or a woman go about finding the right plastic surgeon? In pursue of the best plastic surgeon should they travel to Beverly Hills or should they search the internet? Should they choose a plastic surgeon based on their credentials and degrees? After all, what do these degrees and credentials really mean?

Being a plastic surgeon who has practiced for many years in Southern California and knows many other plastic surgeons in Beverly Hills and Los Angeles, I myself was frustrated when I went about finding the right plastic surgeon for myself! This is how I went about researching the best plastic surgeon for me.

First, I went to the American Society of Plastic Surgeons web site which only lists Board Certified Plastic Surgeons. The other option would be to contact the American Board of Plastic Surgery. This Board is the ONLY recognized board for training and certifying Plastic surgeons for cosmetic surgery of ALL body parts. The Board of Cosmetic surgery is not recognized Board by the American Board of Medical Specialties. Its members can purchase a certificate practically after attending few limited classed without having had a broad surgical training in plastic surgery. The Board of Facial Plastic Surgery offers a certificate to ENT or Otolaryngologist whose training is limited to only that of head and neck.

Once I found the list of all Board Certified plastic surgeons throughout Southern California, including Beverly Hills and Los Angeles, I research them via the California Medical Board to find if they have had complaints or malpractices. Has their medical license ever been restricted or held; and have their privileges to perform surgery at any hospital has been taken away. If a large group of doctors at a prominent hospital no longer allow a certain doctor to practice there, do you want him to practice on you!

Having narrowed my list of Board Certified Plastic Surgeons in Southern California, I wouldn't just choose one from Beverly Hills, Santa Monica, West Los Angeles, or Encino. After all, I am not interested in how beautiful their office looks or if their zip code say 90210. I am not interested in being on the extreme makeover or the swan TV shows. I just want the best plastic surgeon for me. In fact, I am willing to travel a bit to find the most qualified, experienced, and compassionate plastic surgeon who can understand my needs.
Next, I reviewed before and after plastic surgery pictures on their internet web site photo gallery, or at their office. Although it is good to see many before and after pictures on their web sites, some plastic surgeons don't show all their pictures on their web site, because of privacy restraints. In fact, I greatly limit the type and extent of facial pictures that I show on my web site in order to preserve my patient's privacy.

Meet the doctor, and not just his "aesthetic consultant" who speaks with a fancy accent! Does the cosmetic surgeon spend time with you and go over your questions or concerns. Does the plastic surgeon understand what you want, rather than what he wants? Is he or she able to demonstrate to you before and after pictures of other cases similar to you? Is the plastic surgeon honest with you in describing limitations, shortfalls, or even complications that he might have had on similar cases? Also, look at the support staff. Are they friendly? Are they the type of people who are going to be available to you after surgery?

Finally, don't forget that your plastic surgeon, no matter how great, can't perform your surgery in a virtual world. The credentials, skills, and experience of the anesthesiologist who is going to keep you alive during surgery is no less important than the skills of your plastic surgeon. Most patients are not aware that some centers don't even use an anesthesiologist, or don't have the basic monitoring equipments. Fancy office furniture doesn't mean that you will be also having your surgery performed at an accredited and certified Surgery Center. I personally, would not have my surgery in a surgery facility that is not accredited by AAAHC, AAAASF, or Medicare; and doesn't have a Board Certified Anesthesiologist.

Having said all this don't make your this important decision based on advertisements, TV shows, and fads. Trust our gut instinct!

Each year hospitals end up killing twice as many people than automobiles, some 90,000 deaths in the United States. It is not from malpractice, it is due to infections. Hospital infections affect over 2 million patients every year. Scientists are working to prevent these infections one of the newest innovations is silver nano-particles. Microscopic anti-microbial coated nano-particles would be used to keep the infections at bay. Tools used in surgery would be coated with these particles, along with perhaps rubber gloves. One of the companies working on this scheme is AcryMed, which makes surgical devices in Portland, Oregon.

Almost any medical device, which is used in surgery or pokes through the skin are potentially at risk to spread deadly infections. Deadly microbes can live on biofilms or thin layers of slimy biomaterial so small that they cannot be seen without a microscope. If someone is infected it could cost over $50,000 to keep them in the hospital to treat them, obviously the return on investment to sterilize and coat the surgery utensils makes sense. Silver has been used to treat infections throughout time and there are ancient writings of its use in both Greek and Roman writings.

Recently another coating technology has come onto the scene, the use of titanium dioxide, which is being used on laboratory counters, fast food restaurant stainless steel food preparation tables and on military equipment in case of chemical or biological attack. A silver based wound ointment is an obvious use for this technology as well, for military medics and first responders. These coatings are relatively easy to apply using similar hydrophobic methods used in glass coatings to prevent water spots and make them chip resistant. Think on this and all its potential applications.